Gilliland, Frank D
Outdoor air pollution at levels occurring in many urban areas around the world has substantial adverse effects on health. Children in general, and children with asthma in particular, are sensitive to the adverse effects of outdoor air pollutants, including ozone, nitrogen oxides, and respirable particulate matter. A growing number of studies also show that children living in environments near traffic have increased risks of new-onset asthma, asthma symptoms, exacerbations, school absences, and asthma-related hospitalizations. The large population of children exposed to high levels of outdoor air pollutants and the substantial risks for adverse health effects present unexploited opportunities to reduce the burden of asthma. Because the evidence indicates significant adverse effects of air pollution at current levels, there is clearly a need to reduce levels of regulated pollutants such as ozone, as well as unregulated pollutants in tailpipe emissions from motor vehicles. Achieving this long-term goal requires the active involvement of physicians and medical providers to ensure that the health of children is at the top of the list of competing priorities for regulatory policy decision-making. Clinical approaches include treatment to control asthma and patient education to reduce adverse effects of the disease. Reduction in exposures also can be approached at a policy level through changes in schools and school bus operations. Beyond clinical and public health approaches to reduce exposure, another strategy to be used before clean air goals are met is to decrease the susceptibility of children to air pollution. Emerging research indicates that dietary supplementation for individuals with low antioxidant levels is one promising approach to reducing susceptibility to air pollution. A second approach involves induction of enzymatic antioxidant defenses, especially for individuals with at-risk genetic variants of key antioxidant enzymes.
van der Meer, Victor; van Stel, Henk F.; Detmar, Symone B.; Otten, Wilma; Sterk, Peter J.; Sont, Jacob K.
BACKGROUND: Internet and short message service are emerging tools for chronic disease management in adolescents, but few data exist on the barriers to and benefits of internet-based asthma self-management. Our objective was to reveal the barriers and benefits perceived by adolescents with
Meer, V. van der; Stel, H.F. van; Detmar, S.B.; Otten, W.; Sterk, P.J.; Sont, J.K.
Background: Internet and short message service are emerging tools for chronic disease management in adolescents, but few data exist on the barriers to and benefits of internet-based asthma self-management. Our objective was to reveal the barriers and benefits perceived by adolescents with
Khalid, Ayesha N
Stepwise management of asthma remains an area of evolving research. Asthma is one of the most expensive chronic diseases in the United States; stepwise management is an important area of focus, with several recent guidelines recommending management. This is a review of published English language literature, focusing on management guidelines for asthma in adult and pediatric patients. Asthma is a chronic disease whose assessment of severity allows for therapeutic goals to match the impairment noted. Good evidence exists to aid risk reduction, leading to decreased emergency room visits, preventing loss of lung function in adults and lung growth in children, and optimizing pharmacotherapy with reduced side effects profile. Recent asthma management guidelines incorporate 4 components of asthma care including: monitoring of severity, patient education, controlling external triggers, and medications, including recent attention to medication adherence. Asthma is an expensive chronic disease with preventive measures leading to reduced healthcare costs. Future targeted cytokine therapy to decrease serum and blood eosinophils may become an integral part of asthma management. © 2015 ARS-AAOA, LLC.
Full Text Available OBJECTIVES: To establish national baseline information on asthma management practices of physicians, to compare the reported practices with the Canadian Consensus recommendations and to identify results potentially useful for interventions that improve physician asthma management practices.
Kohen, Daniel P.
Describes childhood asthma and a program which teaches relaxation and mental imagery (RMI) exercises to children and adolescents as an adjunct in the management of asthma. Clinical experience indicates children who learn RMI rate their asthma as significantly reduced in severity, miss fewer days of school, and make fewer visits to emergency rooms.…
Pike, Katharine C; Levy, Mark L; Moreiras, John; Fleming, Louise
This review discusses issues related to managing problematic severe asthma in children and young people. A small minority of children have genuinely severe asthma symptoms which are difficult to control. Children with genuinely severe asthma need investigations and treatments beyond those described within conventional guidelines. However, the majority of children with poor symptom control despite high-intensity treatment achieve improvement in their asthma control once attention has been paid to the basics of asthma management. Basic asthma management requires optimisation of inhaler technique and treatment adherence, avoidance of environmental triggers and self-management education. It is also important that clinicians recognise risk factors that predispose patients to asthma exacerbations and potentially life-threatening attacks. These correctable issues need to be tackled in partnership with children and young people and their families. This requires a coordinated approach between professionals across healthcare settings. Establishing appropriate infrastructure for coordinated asthma care benefits not only those with problematic severe asthma, but also the wider asthma population as similar correctable issues exist for children with asthma of all severities. Investigation and management of genuine severe asthma requires specialist multidisciplinary expertise and a systematic approach to characterising patients' asthma phenotypes and delivering individualised care. While inhaled corticosteroids continue to play a leading role in asthma therapy, new treatments on the horizon might further support phenotype-specific therapy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Nowakowski, Alexandra C H; Carretta, Henry J; Dudley, Julie K; Forrest, Jamie R; Folsom, Abbey N
To assess gaps in emergency department (ED) asthma management at Florida hospitals. Survey instrument with open- and closed-ended questions. Topics included availability of specific asthma management modalities, compliance with national guidelines, employment of specialized asthma care personnel, and efforts toward performance improvement. Emergency departments at 10 large hospitals in the state of Florida. Clinical care providers and health administrators from participating hospitals. Compliance with national asthma care guideline standards, provision of specific recommended treatment modalities and resources, employment of specialized asthma care personnel, and engagement in performance improvement efforts. Our results suggest inconsistency among sampled Florida hospitals' adherence to national standards for treatment of asthma in EDs. Several hospitals were refining their emergency care protocols to incorporate guideline recommendations. Despite a lack of formal ED protocols in some hospitals, adherence to national guidelines for emergency care nonetheless remained robust for patient education and medication prescribing, but it was weaker for formal care planning and medical follow-up. Identified deficiencies in emergency asthma care present a number of opportunities for strategic mitigation of identified gaps. We conclude with suggestions to help Florida hospitals achieve success with ED asthma care reform. Team-based learning activities may offer an optimal strategy for sharing and implementing best practices.
Full Text Available The principal aims of asthma management in childhood are to obtain symptom control that allows individuals to engage in unrestricted physical activities and to normalize lung function. These aims should be achieved using the fewest possible medications. Ensuring a correct diagnosis is the first priority. The mainstay of asthma management remains pharmacotherapy. Various treatment options are discussed. Asthma monitoring includes the regular assessment of asthma severity and asthma control, which then informs decisions regarding the stepping up or stepping down of therapy. Delivery systems and devices for inhaled therapy are discussed, as are the factors influencing adherence to prescribed treatment. The role of the pediatric health care provider is to establish a functional partnership with the child and their family in order to minimize the impact of asthma symptoms and exacerbations during childhood.
... Tips to Help Parents Manage Their Child's Asthma Every Day Past Issues / Fall 2013 Table of Contents Asthma ... Tips to Help Parents Manage Their Child's Asthma Every Day Fall 2013 Issue: Volume 8 Number 3 Page ...
Mirabelli, Maria C; Beavers, Suzanne F; Shepler, Samantha H; Chatterjee, Arjun B
Asthma self-management education improves asthma-related outcomes. We conducted this analysis to evaluate variation in the percentages of adults with active asthma reporting components of asthma self-management education by age at asthma onset. Data from 2011 to 2012 Asthma Call-back Surveys were used to estimate percentages of adults with active asthma reporting six components of asthma self-management education. Components of asthma self-management education include having been taught to what to do during an asthma attack and receiving an asthma action plan. Differences in the percentages of adults reporting each component and the average number of components reported across categories of age at asthma onset were estimated using linear regression, adjusted for age, education, race/ethnicity, sex, smoking status, and years since asthma onset. Overall, an estimated 76.4% of adults with active asthma were taught what to do during an asthma attack and 28.7% reported receiving an asthma action plan. Percentages reporting each asthma self-management education component declined with increasing age at asthma onset. Compared with the referent group of adults whose asthma onset occurred at 5-14 years of age, the percentage of adults reporting being taught what to do during an asthma attack was 10% lower among those whose asthma onset occurred at 65-93 years of age (95% CI: -18.0, -2.5) and the average number of components reported decreased monotonically across categories of age at asthma onset of 35 years and older. Among adults with active asthma, reports of asthma self-management education decline with increasing age at asthma onset.
Egypt J Pediatr Allergy Immunol 2008; 6(2): 51-56. 51. Epidemiological Pattern and Management of Pediatric Asthma. Review of Ain Shams Pediatric Hospital Chest Clinic Data. Cairo, Egypt 1995-2004. INTRODUCTION. Bronchial asthma is a major worldwide health problem, which has received increased attention in.
-acting beta-agonists as complementary treatment to inhaled corticosteroids in pediatric asthma management because they provide bronchodilation and bronchoprotection without development of tolerance, and complement the antiinflammatory activity unchecked by steroids. In addition, the Cys-LTRA montelukast has...
Full Text Available Abstract Asthma is the most common respiratory disorder in Canada. Despite significant improvement in the diagnosis and management of this disorder, the majority of Canadians with asthma remain poorly controlled. In most patients, however, control can be achieved through the use of avoidance measures and appropriate pharmacological interventions. Inhaled corticosteroids (ICSs represent the standard of care for the majority of patients. Combination ICS/long-acting beta2-agonists (LABA inhalers are preferred for most adults who fail to achieve control with ICS therapy. Allergen-specific immunotherapy represents a potentially disease-modifying therapy for many patients with asthma, but should only be prescribed by physicians with appropriate training in allergy. Regular monitoring of asthma control, adherence to therapy and inhaler technique are also essential components of asthma management. This article provides a review of current literature and guidelines for the appropriate diagnosis and management of asthma.
Holgate, S.; Bisgaard, H.; Bjermer, L.
Asthma is a highly prevalent condition across Europe and numerous guidelines have been developed to optimise management. However, asthma can be neither cured nor prevented, treatment choices are limited and many patients have poorly controlled or uncontrolled asthma. The Brussels Declaration on A...... reviews the evidence supporting the need for change in asthma management and summarises the ten key points contained in the Brussels Declaration Udgivelsesdato: 2008/12......Asthma is a highly prevalent condition across Europe and numerous guidelines have been developed to optimise management. However, asthma can be neither cured nor prevented, treatment choices are limited and many patients have poorly controlled or uncontrolled asthma. The Brussels Declaration...... on Asthma, sponsored by The Asthma, Allergy and Inflammation Research Charity, was developed to call attention to the shortfalls in asthma management and to urge European policy makers to recognise that asthma is a public health problem that should be a political priority. The Declaration urges recognition...
Kallstrom, Thomas J; Myers, Timothy R
The role of the respiratory therapist (RT) is expanding with the growing acceptance and use of the disease-management paradigm for managing chronic diseases. RTs are key members of the asthma disease-management team, in acute-care settings, patients' homes, out-patient clinics, emergency departments, and in the community. Utilizing RTs as disease managers allows patients to be treated faster and more appropriately, discharged to home sooner, and decreases hospital admissions. RT are leaders in the emerging field of asthma disease management.
Hanley Nadeau, Ellen; Toronto, Coleen E.
Childhood asthma is a growing health concern. Asthma is the most common chronic illness of childhood and a leading cause of emergency room visits, hospitalizations, and school absenteeism. School nurses play a valuable role in asthma management. The purpose of this integrative review is to examine barriers to asthma management for school nurses in…
Zhao, Denise H; Cheung, Janet M Y; Smith, Lorraine; Saini, Bandana
People with asthma spend a significant amount of time in the workplace but little is known about the current state of disease management in such contexts. The aim of the current study is to explore the experiences, attitudes and perceptions of asthma across different stakeholders in the workplace to help inform potential recommendations for workplace asthma policies. Using purposive and convenience sampling methods, in-depth semi-structured interviews were conducted in Australia with 5 human resource personnel, 10 employees with asthma and 10 employees without asthma. Interviews were guided by a schedule of questions focusing on attitudes and experiences of people with asthma in the workplace, which were audio recorded, transcribed verbatim and thematically analysed. Analysis of the qualitative dataset revealed three key themes: Beliefs and Attitudes about Asthma, Asthma Solutions in the Workplace and Workplace Obstacles. Findings suggest that employees with asthma experience problems managing their asthma at work and there is a lack of workplace support in relation to asthma emergency management. Key recommendations for workplace asthma policies have been made to provide better support for employees with asthma. However, further investigation into the experience of managing asthma is required in a wider variety of occupations and work experiences to inform the development of a workplace asthma policy.
Cvetkovski, Biljana; Armour, Carol; Bosnic-Anticevich, Sinthia
To investigate the perceptions and attitudes towards asthma management of general practitioners, pharmacists and people with asthma in a rural area. Qualitative semistructured interviews. Small rural centre in New South Wales. General practitioners, pharmacists and people with asthma in a rural area. General practitioners perceived that the patient provided a barrier to the implementation of optimal asthma services. They were aware that other health care professionals had a role in asthma management but were not aware of the details, particularly in relation to that of the pharmacist and would like to improve communication methods. Pharmacists also perceived the patient to be a barrier to the delivery of optimal asthma management services and would like to improve communication with the general practitioner. The impact of the rural environment for the health care professionals included workforce shortages, availability of support services and access to continuing education. People with asthma were satisfied with their asthma management and the service provided by the health care professionals and described the involvement of family members and ambulance officers in their overall asthma management. The rural environment was an issue with regards to distance to the hospital during an emergency. General practitioners and pharmacists confirmed their existing roles in asthma management while expressing a desire to improve communication between the two professions to help overcome barriers and optimise the asthma service delivered to the patient. The patient described minimal barriers to optimising asthma management, which might suggest that they might not have great expectations of asthma care.
Lin, J T; Wang, W Q; Zhou, X; Wang, C Z; Huang, M; Cai, S X; Chen, P; Lin, Q C; Zhou, J Y; Gu, Y H; Yuan, Y D; Sun, D J; Yang, X H; Yang, L; Huo, J M; Chen, Z C; Jiang, P; Zhang, J; Ye, X W; Liu, H G; Tang, H P; Liu, R Y; Liu, C T; Zhang, W; Hu, C P; Chen, Y Q; Liu, X J; Dai, L M; Zhou, W; Huang, Y J; Xu, J Y
Objective: To investigate warning symptoms of asthma attack and evaluate asthma self-management status of asthma patients in urban China. Methods: A multi-center, cross-sectional, questionnaire-based survey was carried out from 30 general hospitals dispersed in 30 provinces of mainland China (except for Tibet) during Oct 2015 to May 2016. Information of frequency and warning symptoms of asthma attack, the time from warning symptoms to asthma attack, the impact of asthma attack and asthma self-management were collected from asthma patients of outpatient department. Results: Altogether 3 875 asthmatic outpatients were recruited. 78.1% (3 026/3 875) of the patients reported restriction of exercise and daily activities during asthma exacerbation. 82.5% (3 160/3 829) of the patients had warning symptoms before asthma attack, the most common warning symptoms were cough, chest tightness and shortness of breath. The median time from warning symptoms to asthma attack was 2 h, the mean time was 90 h. Only 4.4% (167/3 829) of the patients had definite confidence to control asthma when symptoms deteriorated. 76.7% (2 937/3 828) of the patients used medications to control asthma when asthma symptoms deteriorated. Medication choice: inhaled corticosteroid (ICS) + formoterol 45.8% (1 776/3 875), short-acting beta-agonist (SABA) 23.9% (927/3 875). Conclusions: Most asthma patients have warning symptoms before asthma attack, the most common symptoms are cough, chest tightness and shortness of breath. The proportion of patients conducting effective asthma self-management remains low.
National Heart, Lung, and Blood Inst. (DHHS/NIH), Bethesda, MD. Div. of Lung Diseases.
The Living with Asthma Program is designed to teach asthma self-management skills to children (ages 8-12) with asthma and to give their parents the knowledge and behavior modification skills to help their children take over responsibility for managing the condition. Both groups receive training in problem solving and in ways to improve family…
Sarver, Nancy; Murphy, Kevin
The high burden of asthma indicates suboptimal control of this chronic condition. This review describes approaches for establishing asthma control based on an understanding of potential issues in the achievement and maintenance of asthma control, recent changes in asthma management guidelines that facilitate attainment of treatment goals, and the importance of the healthcare provider-patient partnership to emphasize treatment based on asthma control. Review of the published literature, asthma management guidelines, and patient asthma education resources. Asthma control is best achieved by patient-oriented versus disease-oriented management strategies that incorporate a combination of pharmacologic and nonpharmacologic treatment modalities. Tools that assess and monitor asthma may facilitate the achievement and maintenance of asthma control. Key components of an optimal management strategy include solid partnerships between healthcare providers and patients, comprehensive patient and caregiver education, personalized written asthma action plans, patient-reported evaluation of symptom control, appropriate drug therapy, strategies for improving compliance with asthma medication regimens, and a treatment algorithm that outlines the facets of asthma management. Information presented in this article will guide nurse practitioners in helping patients with asthma achieve and maintain long-term disease control.
Wilson, Candice; Rapp, Kristi Isaac; Jack, Leonard, Jr.; Hayes, Sandra; Post, Robert; Malveaux, Floyd
Background: Focused risk assessment is essential in the effective management of asthma. Purpose: This study identified and examined correlations among areas of pediatric asthma risk and determined associations between these risks and demographic characteristics. Methods: This exploratory study identified risk factors that affect asthma management…
Evans-Agnew, Robin A; Klein, Nicole; Lecce, Sally
Managing asthma in the schools is complex and requires careful planning. This article highlights key steps in implementing guideline-based care for children with asthma in Washington State schools: assessing students, establishing acuity, communicating with parents, and training staff. Advance planning can improve outcomes for students, parents, and school staff in managing this complex and prevalent disease. NASN recently developed asthma management guidelines. Developing state-specific guidelines provides an opportunity to speak specifically to state laws and nurse practice acts while also reinforcing the importance of specialized practice to school nurses, school administrators and teachers, parents, and students. © 2015 The Author(s).
Background: Asthma is an old and common disorder of respiratory function whose prevalence is increasing everywhere particularly in urban centres. This situation, coupled with the problem of suboptimal management has led to an increase in the morbidity of the disease and enormous economic losses through lost ...
Disparities in asthma management are a burden on African American youth. The objective of this study is to describe and compare the discourses of asthma management disparities (AMDs) in African American adolescents in Seattle to existing youth-related asthma policies in Washington State. Adolescents participated in a three-session photovoice…
Jones, Dean P.; Brown, Lou Ann S.
Abstract Asthma is a chronic inflammatory disorder of the airways associated with airway hyper-responsiveness and airflow limitation in response to specific triggers. Whereas inflammation is important for tissue regeneration and wound healing, the profound and sustained inflammatory response associated with asthma may result in airway remodeling that involves smooth muscle hypertrophy, epithelial goblet-cell hyperplasia, and permanent deposition of airway extracellular matrix proteins. Although the specific mechanisms responsible for asthma are still being unraveled, free radicals such as reactive oxygen species and reactive nitrogen species are important mediators of airway tissue damage that are increased in subjects with asthma. There is also a growing body of literature implicating disturbances in oxidation/reduction (redox) reactions and impaired antioxidant defenses as a risk factor for asthma development and asthma severity. Ultimately, these redox-related perturbations result in a vicious cycle of airway inflammation and injury that is not always amenable to current asthma therapy, particularly in cases of severe asthma. This review will discuss disruptions of redox signaling and control in asthma with a focus on the thiol, glutathione, and reduced (thiol) form (GSH). First, GSH synthesis, GSH distribution, and GSH function and homeostasis are discussed. We then review the literature related to GSH redox balance in health and asthma, with an emphasis on human studies. Finally, therapeutic opportunities to restore the GSH redox balance in subjects with asthma are discussed. Antioxid. Redox Signal. 17, 375–408. PMID:22304503
Kawahara, Noriko; Hasegawa, Shunji; Hashimoto, Kunio; Matsubara, Tomoyo; Ichiyama, Takashi; Furukawa, Susumu
There have been no reports on the evaluation of the usefulness of long-term asthma management based on the Japanese Pediatric Guideline for the Treatment and Management of Bronchial Asthma 2005 (JPGL 2005). The purpose of the present study was to retrospectively investigate the records of 350 patients admitted to Yamaguchi University Hospital who had asthma attacks from January 2006 to June 2008. There were 149 patients who were treated for more than 3 months in accordance with the guideline (long-term management group) and 201 who were not (non-long-term management group). The patients were divided into three age groups: 100 infants, 159 toddlers, and 91 schoolchildren. The onset age of asthma in the long-term management group was earlier than that in the non-long-term management group in toddlers and schoolchildren. The white blood cell counts and C-reactive protein levels were higher in the non-long-term management group in schoolchildren, suggesting the complication of some infections. The severity of asthma in the long-term management group was greater than that in the non-long-term management group among all three age groups. There were no significant differences, however, in the severity of asthma attack at admission between the long-term and non-long-term management groups in the three age groups. Patients who had severe asthma tended to be treated with long-term management, which suggests that long-term asthma management according to JPGL 2005 may reduce the severity of asthma attack at that admission, because the severity of asthma in patients undergoing long-term management correlates with the severity of asthma attack.
Hanley Nadeau, Ellen; Toronto, Coleen E
Childhood asthma is a growing health concern. Asthma is the most common chronic illness of childhood and a leading cause of emergency room visits, hospitalizations, and school absenteeism. School nurses play a valuable role in asthma management. The purpose of this integrative review is to examine barriers to asthma management for school nurses in the school setting. Findings revealed multiple barriers school nurses encounter in managing asthma. Six themes emerged that included lack of resources and support, insufficient time, communication challenges, limited knowledge, and lack of awareness of school nurses' expertise. Students, parents, primary care physicians, school administration, staff, and school nurses themselves all play a role in constructing barriers to asthma management. There is a need for school nurses and school nurse leaders to focus efforts to develop strategies to overcome barriers to ensure evidence-based, best practice management of asthma in the school setting. © The Author(s) 2015.
Roberts, James R.; McCurdy, Leyla Erk
These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health care providers, and outlines the environmental interventions…
Moricca, Michelle L.; Grasska, Merry A.; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C.; Galant, Stanley P.
Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided…
Morten, Matthew; Collison, Adam; Murphy, Vanessa E; Barker, Daniel; Oldmeadow, Christopher; Attia, John; Meredith, Joseph; Powell, Heather; Robinson, Paul D; Sly, Peter D; Gibson, Peter G; Mattes, Joerg
The single-center double-blind, randomized controlled Managing Asthma in Pregnancy (MAP) trial in Newcastle, Australia, compared a treatment algorithm using the fraction of exhaled nitric oxide (FENO) in combination with asthma symptoms (FENO group) against a treatment algorithm using clinical symptoms only (clinical group) in pregnant asthmatic women (Australian New Zealand Clinical Trials Registry, no. 12607000561482). The primary outcome was a 50% reduction in asthma exacerbations during pregnancy in the FENO group. However, the effect of FENO-guided management on the development of asthma in the offspring is unknown. We sought to investigate the effect of FENO-guided asthma management during pregnancy on asthma incidence in childhood. A total of 179 mothers consented to participate in the Growing into Asthma (GIA) double-blind follow-up study with the primary aim to determine the effect of FENO-guided asthma management on childhood asthma incidence. A total of 140 children (78%) were followed up at 4 to 6 years of age. FENO-guided as compared to symptoms-only approach significantly reduced doctor-diagnosed asthma (25.9% vs 43.2%; odds ratio [OR], 0.46, 95% CI, 0.22-0.96; P = .04). Furthermore, frequent wheeze (OR, 0.27; 95% CI, 0.09-0.87; P = .03), use of short-acting β-agonists (OR, 0.49; 95% CI, 0.25-0.97; P = .04), and emergency department visits for asthma (OR, 0.17; 95% CI, 0.04-0.76; P = .02) in the past 12 months were less common in children born to mothers from the FENO group. Doctor-diagnosed asthma was associated with common risk alleles for early onset asthma at gene locus 17q21 (P = .01 for rs8069176; P = .03 for rs8076131), and higher airways resistance (P = .02) and FENO levels (P = .03). A causal mediation analysis suggested natural indirect effects of FENO-guided asthma management on childhood asthma through "any use" and "time to first change in dose" of inhaled corticosteroids during the MAP trial (OR: 0.83; 95% CI: 0
Acute asthma is one of the most common reasons for children presenting to the emergency department. International guidelines for the management of acute paediatric asthma are widely available. In this study we examined how acute asthma in children is managed across hospitals in Ireland and compared Irish practice with standard international guidelines. We surveyed 54 paediatricians across 18 centres in Ireland. A total of 30 (55.5%) individual paediatricians across 17 (94%) centres replied. The majority of centres had a written protocol for the management of acute asthma. A large number of centres use MDI and spacer devices in acute management although doses used varied widely. Only 29% of centres had written asthma action plans available from the emergency department and 53% had plans available from the ward. Irish practice is largely inline with established guidelines. A national asthma strategy could further help to improve asthma care.
... lungs. When symptoms flare up, it’s called an asthma attack. The airways of people with asthma are prone ... every day to help control symptoms and prevent asthma attacks. “Inhaled corticosteroids are recommended as the preferred long- ...
... BS, Burks AW, et al, eds. Middleton's Allergy Principles and Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 55. Lugogo N, Que LG, Gilstrap DL, Kraft M. Asthma: clinical diagnosis and management. In: Broaddus VC, Mason RJ, Ernst JD, et ...
Tai, Teresa; Bame, Sherry I
Asthma is a leading chronic illness among American children. School-based health clinics (SBHCs) reduced expensive ER visits and hospitalizations through better healthcare access and monitoring in select case studies. The purpose of this study was to examine the cost-benefit of SBHC programs in managing childhood asthma nationwide for reduction in medical costs of ER, hospital and outpatient physician care and savings in opportunity social costs of lowing absenteeism and work loss and of future earnings due to premature deaths. Eight public data sources were used to compare costs of delivering primary and preventive care for childhood asthma in the US via SBHC programs, including direct medical and indirect opportunity costs for children and their parents. The costs of nurse staffing for a nationwide SBHC program were estimated at $4.55 billion compared to the estimated medical savings of $1.69 billion, including ER, hospital, and outpatient care. In contrast, estimated total savings for opportunity costs of work loss and premature death were $23.13 billion. Medical savings alone would not offset the expense of implementing a SBHC program for prevention and monitoring childhood asthma. However, even modest estimates of reducing opportunity costs of parents' work loss would be far greater than the expense of this program. Although SBHC programs would not be expected to affect the increasing prevalence of childhood asthma, these programs would be designed to reduce the severity of asthma condition with ongoing monitoring, disease prevention and patient compliance.
Ricciardolo, Fabio L M; Sorbello, Valentina; Ciprandi, Giorgio
The current review aims to revisit literature on exhaled nitric oxide (FeNO) in asthma phenotyping and management to clarify the utility of this test in clinical practice. It is increasingly evident that multiple profiles characterize asthma as a complex disease for which is necessary to find tools able to discriminate among these phenotypes to achieve the best therapeutic strategy for all asthmatic patients. Current findings indicate that FeNO, a noninvasive and easy-to-obtain biomarker, can be considered a useful tool in predicting asthma developing and exacerbation, in identifying specific asthma phenotypes, in improving asthma diagnosis and management in a selected population, and in monitoring efficacy of standard corticosteroid and biologic therapy. Based on this evidence, FeNO might become an appropriate tool for physicians to better define specific asthma phenotypes and to better deal with asthma worsening.
Scott, Hayley A; Wood, Lisa G; Gibson, Peter G
Obesity is a commonly reported comorbidity in asthma, particularly in severe asthma. Obese asthmatics are highly symptomatic with a poor quality of life, despite using high-dose inhaled corticosteroids. While the clinical manifestations have been documented, the aetiologies of obese-asthma remain unclear. Several potential mechanisms have been proposed, including poor diet quality, physical inactivity and consequent accrual of excess adipose tissue. Each of these factors independently activates inflammatory pathways, potentially exerting effects in the airways. Because the origins of obesity are multifactorial, it is now believed there are multiple obese-asthma phenotypes, with varied aetiologies and clinical consequences. In this review, we will describe the clinical implications of obesity in people with asthma, our current understanding of the mechanisms driving this association and describe recently proposed obese-asthma phenotypes. We will then discuss how asthma management is complicated by obesity, and provide graded recommendations for the management of obesity in this population.
Reddel, Helen K; Ampon, Rosario D; Sawyer, Susan M; Peters, Matthew J
Overuse of asthma relievers, particularly without anti-inflammatory preventers, increases asthma risks. This study aimed to identify how many reliever-only users have urgent healthcare, explore their attitudes and beliefs about asthma and its treatment, and investigate whether purchasing over-the-counter relievers was associated with worse asthma outcomes than by prescription. Cross-sectional population-based Internet survey in Australia. Of 2686 participants ≥16 years with current asthma randomly drawn from a web-based panel, 1038 (50.7% male) used only reliever medication. Urgent asthma-related healthcare; Asthma Control Test (ACT); patient attitudes about asthma and medications; reliever purchase (with/without prescription). Of 1038 reliever-only participants, 23.3% had required urgent healthcare for asthma in the previous year, and only 36.0% had a non-urgent asthma review. Those needing urgent healthcare were more likely than those without such events to be male (56.5% vs 49.0%, p=0.003) and current smokers (29.4% vs 23.3%, p=0.009). Only 30.6% had well-controlled asthma (ACT ≥20) compared with 71.0% of those with no urgent healthcare (pasthma symptoms (vs 5.5% of those without urgent healthcare). Those with urgent healthcare were more frustrated by their asthma and less happy with how they managed it, and they were less confident about their ability to manage worsening asthma, but just as likely as those without urgent healthcare to manage worsening asthma themselves rather than visit a doctor. Reliever-only users purchasing over-the-counter relievers were no more likely than those purchasing relievers by prescription to have uncontrolled asthma (35.9% vs 40.6%, p=0.23) but were less likely to have had a non-urgent asthma review. One-quarter of the reliever-only population had needed urgent asthma healthcare in the previous year, demonstrating the importance of identifying such patients. Their attitudes and beliefs suggest opportunities for targeting this
Garnett, Victoria; Smith, Joanna; Ormandy, Paula
Aim To explore and describe child-parent shared decision making for the management of childhood asthma. Methods A qualitative, descriptive, interview-based study was undertaken. Eight children and nine parents participated. The framework approach underpinned data analysis. Findings A dynamic model of the way children and parents transfer, shift and share asthma management decisions was uncovered. Asthma management decisions between children and parents were non-linear, with responsibility transferring from parent to child under different conditions. Children made a range of decisions about their asthma, often sharing decisions with their parents. However, during acute illness episodes, children often relied on parents to make decisions about their asthma. Conclusion Neither the child nor parent has complete autonomy over asthma management decisions. Decision making is a dynamic, shifting and shared process, dependent on contextual factors and child and parent decision preferences.
Maspero, Jorge; Jardim, Jose; González-Díaz, Sandra; Aranda, Alvaro; Tassinari, Paolo
Background In 2003, the Asthma Insights and Reality in Latin America (AIRLA) survey assessed, in part, perception, knowledge, and attitudes related to asthma.1 In 2011 the Latin America Asthma Insight and Management (LA AIM) survey was designed to ascertain the realities of living with asthma, disconnect between expectations in asthma management and patient experience, and unmet needs. Using results from our survey, we investigated the advances made in asthma care and the challenges that rema...
Background: Optimal management of asthma in resource limited settings is hindered by lack of resources, making it difficult for health providers to adhere to international guidelines. The purpose of this review is to identify steps for asthma diagnosis and management in resource limited settings. Methods: Review of ...
Meer, Victor van der
This thesis describes the role of internet-based support in the delivery of an asthma self management program. First, the compliance and reliability of home lung function monitoring, one of the key features of asthma self-management, was studied and appeared to be high over a 4-week period. Second,
Andersen, Torben Juul; Garvey, Maxine; Roggi, Oliviero
outcomes. This topic is timely and of interest both to the academic community as well as to practicing managers, executives, and directors. The volume focuses on contemporary risk leadership issues based on recent research insights but avoids excessive technical language and mathematical formulas. The book...... is framed around the challenges imposed on executives and directors in dealing with an increasingly complex and unpredictable world. This requires a new risk leadership focus that not only avoids the downside risks but also considers ways to exploit the upside potential offered by a dynamic environment....... The underlying logic is built on the principles of financial economics where benefits derive from reducing bankruptcy costs and increasing future cash inflows. This provides a stringent framework for analyzing the effect of different risk management actions and behaviors in effective risk-taking organizations...
D'Souza, W; Crane, J; Burgess, C; Te Karu, H; Fox, C; Harper, M; Robson, B; Howden-Chapman, P; Crossland, L; Woodman, K
Although asthma self-management plans are widely recommended as essential in the long-term treatment of adult asthma, there have been few studies examining their use. Our objective was to assess the effect of a "credit card" adult asthma self-management plan in a community experiencing major health problems from asthma, by means of a before and after intervention trial of the efficacy of the "credit card" plan, when introduced through community-based asthma clinics. The participants were 69 Maori people with asthma. The "credit card" plan consisted of written guidelines for the self-management of asthma, based on self-assessment of asthma severity, printed on a plastic card. On one side, management guidelines were based on the interpretation of peak expiratory flow rate (PEFR) recordings, whilst the reverse side was based on symptoms. The outcome measures used were before and after comparison of markers of asthma morbidity and requirement for acute medical treatment; and a structured questionnaire assessing the acceptability and use of the credit card plan. Following the introduction of the plan, the mean PEFR increased from 347 to 389 l.min-1, the percentage of nights woken fell from 30.4 to 16.9%, and the number of days "out of action" fell from 3.8 to 1.7%. The requirements for acute medical treatment also fell during the intervention period. Most participants commented favourably on the content and usefulness of the plan. In the situation of worsening asthma, 28% of subjects found the peak flow side of the card most helpful, 7% the symptoms side, and 48% found both sides equally helpful.(ABSTRACT TRUNCATED AT 250 WORDS)
Andersen, Torben Juul; Garvey, Maxine; Roggi, Oliviero
outcomes. This topic is timely and of interest both to the academic community as well as to practicing managers, executives, and directors. The volume focuses on contemporary risk leadership issues based on recent research insights but avoids excessive technical language and mathematical formulas. The book...... is framed around the challenges imposed on executives and directors in dealing with an increasingly complex and unpredictable world. This requires a new risk leadership focus that not only avoids the downside risks but also considers ways to exploit the upside potential offered by a dynamic environment...
Anderson, William C; Apter, Andrea J; Dutmer, Cullen M; Searing, Daniel A; Szefler, Stanley J
In this year's Advances in Asthma review, we discuss viral infections in asthmatic patients and potential therapeutic agents, the microbiome, novel genetic associations with asthma, air quality and climate effects on asthma, exposures during development and long-term sequelae of childhood asthma, patient-centered outcomes research, and precision medicine. In addition, we discuss application of biomarkers to precision medicine and new information on asthma medications. New evidence indicates that rhinovirus-triggered asthma exacerbations become more severe as the degree of sensitization to dust mite and mouse increase. The 2 biggest drivers of asthma severity are an allergy pathway starting with allergic sensitization and an environmental tobacco smoke pathway. In addition, allergic sensitization and blood eosinophils can be used to select medications for management of early asthma in young children. These current findings, among others covered in this review, represent significant steps toward addressing rapidly advancing areas of knowledge that have implications for asthma management. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
The National Asthma Awards recognizes health plans, healthcare providers and communities in action that demonstrate an environmental component to address asthma triggers, collaborate with others and save healthcare dollars with their programming.
Thomson, Neil C.; Chaudhuri, Rekha
Omalizumab, a humanized monoclonal antibody that binds circulating IgE antibody, is a treatment option for patients with moderate to severe allergic asthma whose asthma is poorly controlled with inhaled corticosteroids and inhaled long-acting β 2 agonist bronchodilators. This review considers the mechanism of action, pharmacokinetics, efficacy, safety and place in management of omalizumab in asthma and focuses particularly on key articles published over the last three years. Omalizumab reduce...
Asthma, one of the most common chronic disorders in childhood, affects more than seven million children in the United States, and is the third leading cause of hospitalization for children. Statistics like these make planning and preparing for asthma in the early childhood setting a high priority. With the high rates of asthma in the U.S. today,…
Horner, Sharon D; Brown, Adama; Brown, Sharon A; Rew, D Lynn
To test the effects of 2 modes of delivering an asthma educational intervention on health outcomes and asthma self-management in school-aged children who live in rural areas. Longitudinal design with data collected 4 times over 12 months. The target sample was composed of children in grades 2-5 who had a provider diagnosis of asthma. Elementary schools were stratified into high or low socioeconomic status based on student enrollment in the free or reduced-cost lunch program. Schools were then randomly assigned to 1 of 3 treatment arms: in-school asthma class, asthma day camp, or the attention-control group. Sample retention was good (87.7%) and equally distributed by study arm. Improvements in emergency department visits and office visits were related to attending either the asthma class or asthma day camp. Asthma severity significantly decreased in both asthma treatment groups. Other factors such as hospitalizations, parent asthma management, and child asthma management improved for all groups. Both asthma class and asthma day camp yielded significant reductions in asthma severity. There were reductions in the emergency department and office visits for the 2 asthma arms, and hospitalizations declined significantly for all groups. Asthma self-management also improved in all groups, while it was somewhat higher in the asthma arms. This may be due to the attention being drawn to asthma management by study participation and the action of completing questionnaires about asthma management, asthma symptoms, and health outcomes. © 2015 National Rural Health Association.
Magzamen, Sheryl; Brandt, Sylvia J.; Tager, Ira B.
National guidelines on the effective management of pediatric asthma have been promoted for over 20 years, yet asthma-related morbidity among low-income children remains disproportionately high. To date, household and clinical interventions designed to remediate these differences have been informed largely by a health behavior framework. However,…
MELLIS, CM; BOWES, G; HENRY, RL; MITCHELL, CA; PHELAN, PD; SHAH, S; SHAROTA, L; STAUGAS, R; SLY, PD; YOUNG, L
Since asthma is the most common chronic illness in childhood, many of the problems associated with this condition will impact on the child's education. Because of widespread concerns regarding the management of asthma in schools, a subcommittee of the Thoracic Society of Australia and New Zealand,
Naar-King, Sylvie; Ellis, Deborah; Kolmodin, Karen; Cunningham, Phillippe; Secord, Elizabeth
African-American adolescents have the highest rates of asthma morbidity and mortality, yet there are few successful behavioral interventions to improve illness management for this group. Mental health providers have an opportunity to expand their services and impact by targeting adolescents with poor asthma management. We describe the adaptation…
Salvi, Sundeep S; Apte, Komalkirti K; Dhar, Raja; Shetty, Pradeep; Faruqi, Rab A; Thompson, Philip J; Guleria, Randeep
Despite a better understanding of the pathophysiology of asthma, presence of reliable diagnostic tools, availability of a wide array of effective and affordable inhaled drugs and simplified national and international asthma management guidelines, asthma remains poorly managed in India. The Asia-Pacific Asthma Insight and Management (AP-AIM) study was aimed at understanding the characteristics of asthma, current management, level of asthma control and its impact on quality of life across Australia, China, Hong Kong, India, Malaysia, Singapore, South Korea, Taiwan and Thailand. This paper describes the results of asthma management issues in India in detail and provides a unique insight into asthma in India. The AP-AIM India study was conducted in eight urban cities in India, viz: Ajmer, Delhi, Kolkata, Rourkela, Chennai, Mangalore, Mumbai and Rajkot from February to July 2011. Face-to-face interviews were conducted in adult asthmatics and parents of asthmatic children between the ages of 12 and 17 years with a confirmed diagnosis or a treatment history of 1 year for asthma. Four hundred asthmatics (M:F::1:1.273), with a mean age of 50 ± 17.8 years, from across India were studied. 91% of the asthmatics in India perceived their asthma to be under control, however, none of the asthmatics had controlled asthma by objective measures. Asthmatics in India believed that their asthma was under control if they have up to 2 emergency doctor visits a year. The quality of life of these patients was significantly affected with 93% school/work absenteeism and a loss of 50% productivity. Seventy-five percent of the asthmatics have never had a lung function test. The common triggers for asthmatics in India were dust (49%) and air pollution (49%), while only 5% reported of pollen as triggers. Eighty-nine percent of Indian asthmatics reported an average use of oral steroids 10.5 times a year. Only 36% and 50% of Indian asthmatics used controller and rescue inhalers with a majority
People with intellectual disability are a vulnerable group of people with asthma that has, to date, largely been ignored in the medical literature. Although guidelines for medication management for people with intellectual disability suggest asthma is treated as for other populations, there are special considerations that should be taken into account when managing asthma in this group. Due to their cognitive impairment as well as comorbidities, they are likely to require support with asthma self-management, including inhaler use. Their varying degrees of autonomy mean that there is often a need to provide education and information to both the person and their caregivers. Educational aims To understand general principles of health of people with intellectual disability and how this affects the healthcare professional’s approach to asthma management. To understand how intellectual disability affects cognition, autonomy and communication, and therefore the ability of a person to self-manage asthma. To recognise ways of mitigating respiratory disease risk in people with intellectual disability. To describe ways for healthcare professionals to support people with intellectual disability and their caregivers in asthma management. PMID:28210318
Hazir, T; Das, C; Piracha, F; Waheed, B; Azam, M; Tam, A
Methods: Subjects were children's parents/guardians visiting the asthma clinic, Children's Hospital, Islamabad. The questionnaire included items on general understanding of asthma, its triggers, and management.
Saglani, Sejal; Fleming, Louise
Children with difficult asthma have significant morbidity and fail to achieve asthma control despite being prescribed high dose maintenance treatment. If control remains poor after diagnostic confirmation, detailed assessments of the reasons for asthma being difficult-to-control are needed. Underlying modifiable factors including non-adherence to medication, persistent environmental exposures that trigger asthma symptoms and psychosocial factors contribute to poor control in these patients. The focus of this review is to provide a practical approach to the diagnosis and management of difficult asthma including an overview of long term assessments to identify potential progression to true, severe asthma. A multi-disciplinary team is critical to enable modifiable factors to be identified and addressed. Significant resources are required to manage paediatric difficult asthma optimally and only specialist centres should be tasked with the assessment of these patients. Although this may have an impact on healthcare resources, long term benefits for lung health are significant. Expert commentary: The management of paediatric difficult asthma is not simple and involves numerous professionals with varied expertise. However, if it is not undertaken with the appropriate skills, there is a significant risk of children receiving inappropriate invasive investigations and therapies that will have no impact on morbidity.
Barrett, Meredith A; Humblet, Olivier; Marcus, Justine E; Henderson, Kelly; Smith, Ted; Eid, Nemr; Sublett, J Wesley; Renda, Andrew; Nesbitt, LaQuandra; Van Sickle, David; Stempel, David; Sublett, James L
Asthma inflicts a significant health and economic burden in the United States. Self-management approaches to monitoring and treatment can be burdensome for patients. To assess the effect of a digital health management program on asthma outcomes. Residents of Louisville, Kentucky, with asthma were enrolled in a single-arm pilot study. Participants received electronic inhaler sensors that tracked the time, frequency, and location of short-acting β-agonist (SABA) use. After a 30-day baseline period during which reference medication use was recorded by the sensors, participants received access to a digital health intervention designed to enhance self-management. Changes in outcomes, including mean daily SABA use, symptom-free days, and asthma control status, were compared among the initial 30-day baseline period and all subsequent months of the intervention using mixed-model logistic regressions and χ 2 tests. The mean number of SABA events per participant per day was 0.44 during the control period and 0.27 after the first month of the intervention, a 39% reduction. The percentage of symptom-free days was 77% during the baseline period and 86% after the first month, a 12% improvement. Improvement was observed throughout the study; each intervention month demonstrated significantly lower SABA use and higher symptom-free days than the baseline month (P asthma during the baseline period, 67% during the first month of the intervention. Each intervention month demonstrated significantly higher percentages than the baseline month (P asthma management intervention demonstrated significant reductions in SABA use, increased number of symptom-free days, and improvements in asthma control. ClinicalTrials.gov Identifier: NCT02162576. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Quaranta, Judith E.; Spencer, Gale A.
Ten million children in the United States have asthma. Since children are in school about 6 hr a day, school nurses are positioned to intervene and influence asthma outcomes. A descriptive correlational study was designed to investigate performance of school nurses' asthma management behaviors in relationship to asthma knowledge, asthma attitude,…
Kwong, Kenny Yat-Choi; Redjal, Nasser; Scott, Lyne; Li, Marilyn; Thobani, Salima; Yang, Brian
Asthma management programs, such as the Breathmobile program, have been extremely effective in reducing asthma morbidity and increasing disease control; however, their high start-up costs may preclude their implementation in smaller health systems. In this study, we extended validated asthma disease management principles from the Breathmobile program to a smaller clinic system utilizing existing resources and compared clinical outcomes. Cox-regression analyses were conducted to determine the cumulative probability that a new patient entering the program would achieve improved clinical control of asthma with each subsequent visit to the program. A weekly asthma disease management clinic was initiated in an existing multi-specialty pediatric clinic in collaboration with the Breathmobile program. Existing nursing staff was utilized in conjunction with an asthma specialist provider. Patients were referred from a regional healthcare maintenance organization and patients were evaluated and treated every 2 months. Reduction in emergency department (ED) visits and hospitalizations, and improvements in asthma control were assessed at the end of 1 year. A total of 116 patients were enrolled over a period of 1 year. Mean patient age was 6.4 years at the time of their first visit. Patient ethnicity was self-described predominantly as Hispanic or African American. Initial asthma severity for most patients, classified in accordance with national guidelines, was "moderate persistent." After 1 year of enrollment, there was a 69% and 92% reduction in ED/urgent care visits and hospitalizations, respectively, compared with the year before enrollment. Up to 70% of patients achieved asthma control by the third visit. Thirty-six different patients were seen during 1 year for a total of $15,938.70 in contracted reimbursements. A large-scale successful asthma management program can be adapted to a stationary clinic system and achieve comparable results.
Full Text Available David Price,1,2 Leif Bjermer,3 David A Bergin,4 Rafael Martinez5 1Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK; 2Observational and Pragmatic Research Institute, Singapore; 3Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden; 4Novartis Ireland Limited, Dublin, Ireland; 5Novartis Pharma AG, Basel, Switzerland Abstract: Heterogeneity of asthma and difficulty in achieving optimal control are the major challenges in the management of asthma. To help attain the best possible clinical outcomes in patients with asthma, several guidelines provide recommendations for patients who will require a referral to a specialist. Such referrals can help in clearing the uncertainty from the initial diagnosis, provide tailored treatment options to patients with persistent symptoms and offer the patients access to health care providers with expertise in the management of the asthma; thus, specialist referrals have a substantial impact on disease prognosis and the patient’s health status. Hurdles in implementing these recommendations include lack of their dissemination among health care providers and nonadherence to these guidelines; these hurdles considerably limit the implementation of specialist referrals, eventually affecting the rate of referrals. In this review, recommendations for specialist referrals from several key international and national asthma guidelines and other relevant published literature are evaluated. Furthermore, we highlight why referrals are not happening, how this can be improved, and ultimately, what should be done in the specialist setting, based on existing evidence in published literature. Keywords: asthma, disease management, specialization, primary care physicians, referral
Svavarsdottir, Erla Kolbrun; Garwick, Ann W; Anderson, Lori S; Looman, Wendy S; Seppelt, Ann; Orlygsdottir, Brynja
This article is a report of an international study of barriers to asthma care from the perspectives of school nurses in Reykjavik, Iceland and St. Paul, Minnesota, in the context of their schools, communities and countries. Globally, asthma affects the health and school performance of many adolescents. School nurses play a key role by providing care to adolescents with asthma in school settings. Understanding universal barriers to asthma management in schools is important for developing interventions that are effective in multiple societal contexts. Exploratory, descriptive study. Parallel studies were conducted from September 2008-January 2009, through six focus groups among school nurses (n = 32, in Reykjavik n = 17 and St. Paul n = 15) who were managing asthma in adolescents. Focus groups were audio-recorded and transcribed verbatim in English or Icelandic. The Icelandic transcripts were translated into English. Descriptive content analytic techniques were used to systematically identify and categorize types of barriers to asthma care. School nurses in both countries identified common barriers, such as time constraints, communication challenges and school staff barriers. The primary difference was that St. Paul school nurses identified more socio-economic and health access barriers than school nurses in Reykjavik. Greater cultural and linguistic diversity and socio-economic differences in the student population in St. Paul and lack of universal healthcare coverage in the US contributed to school nurses' need to focus more on asthma management than school nurses in Reykjavik, who were able to focus more on asthma prevention and education. © 2012 Blackwell Publishing Ltd.
Bereznicki, Bonnie J; Beggs, Sean; Duff, Caitlin; Bereznicki, Luke
Little is known about doctors' treatment preferences for childhood asthma. The aim of this study was to investigate adherence to management guidelines for childhood asthma. One thousand general practitioners (GPs) and paediatric specialists in Australia were invited to take part in a survey, which collected demographic details and explored their familiarity with and adherence to childhood asthma management guidelines. Two hundred doctors (20% response rate) responded and were eligible for inclusion in the survey. Approximately half (54.5%) of the respondents were very familiar with at least one of the childhood asthma management guidelines. The majority of respondents (86.8%) followed guideline recommendations when prescribing initial maintenance therapy for childhood asthma, while 89.2% and 68.0% followed guideline recommendations regarding step-up and step-down therapy respectively. Overall familiarity with childhood asthma management guidelines could be improved. There is scope for improvement in the adherence to these guidelines when prescribing medication in childhood asthma, particularly for step-down therapy.
Challenges in the Management of Bronchial Asthma Among Adults in Nigeria: A Systematic ... Annals of Medical and Health Sciences Research ... Nigerian Thoracic Society, pharmaceutical industries, and the health‑care workers in general.
Lin, J T; Wang, W Q; Zhou, X; Yin, K S; Liu, C T; Wang, C Z; Huang, M; Chen, P; Yuan, Y D; Cai, S X; Wu, C G; Li, J; Lin, Q C; Zhou, J Y; Liu, H G; Gu, Y H; Huang, X G; Sun, D J; Yang, X H; Yang, L; Huo, J M; Chen, Z C; Zhou, W; Jiang, P; Tang, H P; Liu, R Y; Zhang, W; Chen, Y Q; Huang, Y J; Liu, X J; Dai, L M; Ye, X W; Hu, C P; Zhang, J; Xu, J Y
Objective: To evaluate the changes of asthma control, disease management and perception in recent years in China. Methods: We conducted 2 multi-center, cross-sectional surveys. Outpatient asthmatic patients from 10 cities in mainland China (2007-2008) and 30 central cities from 30 provinces in China (except Tibet)(2015-2016) were recruited respectively. Data of asthma control, disease management and perception from the 2 surveys were compared for 10 cities which took part in both of the 2 surveys. Chi-square test was used for comparison between groups. Results: The asthma control level improved from 28.7%(839/2 928) in 2007-2008 to 39.2%(533/1 361) in 2015-2016( P control asthma when asthma symptoms deteriorated in 2015-2016, which was higher than the result of 2007-2008(31.8%, 803/2 524)( P control and disease perception in China improved significantly in recent years, while the rate of PFM usage showed no significant improvement. Asthma action plan including PFM monitoring and asthma self-management should be further promoted nationwide.
Wande O. Benka-Coker
Full Text Available Community-level approaches for pediatric asthma management rely on locally collected information derived primarily from two sources: claims records and school-based surveys. We combined claims and school-based surveillance data, and examined the asthma-related risk patterns among adolescent students.Symptom data collected from school-based asthma surveys conducted in Oakland, CA were used for case identification and determination of severity levels for students (high and low. Survey data were matched to Medicaid claims data for all asthma-related health care encounters for the year prior to the survey. We then employed recursive partitioning to develop classification trees that identified patterns of demographics and healthcare utilization associated with severity.A total of 561 students had complete matched data; 86.1% were classified as high-severity, and 13.9% as low-severity asthma. The classification tree consisted of eight subsets: three indicating high severity and five indicating low severity. The risk subsets highlighted varying combinations of non-specific demographic and socioeconomic predictors of asthma prevalence, morbidity and severity. For example, the subset with the highest class-prior probability (92.1% predicted high-severity asthma and consisted of students without prescribed rescue medication, but with at least one in-clinic nebulizer treatment. The predictive accuracy of the tree-based model was approximately 66.7%, with an estimated 91.1% of high-severity cases and 42.3% of low-severity cases correctly predicted.Our analysis draws on the strengths of two complementary datasets to provide community-level information on children with asthma, and demonstrates the utility of recursive partitioning methods to explore a combination of features that convey asthma severity. Keywords: Asthma, Classification, Risk stratification, Statistical data analysis, Disease management
Full Text Available Introduction. Recently published national and international guidelines stress the importance of self-management in asthma. They have recommended that self-management plans should be an essential part of the long-term management of asthmatic patients. These plans essentially focus on the early recognition of unstable or deteoriorating asthma, by monitoring peak flow or symptoms. Objective. The aim of our one-year study was to compare the efficacy of peak-flow based self-management of asthma with traditional treatment. Method. Sixty clinically stable adult patients with mild and moderate persistent asthma were randomly allocated to peakflow based self-management (Group A, n=30 or to conventional treatment (Group B, n=30, with no significant difference between groups in terms of age, sex distribution and initial lung function. The recorded measurements were: lung function, asthma exacerbations, unscheduled ambulatory care facilities (hospital-based emergency department, consultations with general practitioner or pulmonologist, courses of oral prednisolone, courses of antibiotics, days off work. Results. There was a significant difference between groups in number of asthma exacerbations (p<0.05, unscheduled visits to ambulatory care facilities (p<0.005, days off work (p<0.0001, courses of oral prednisolone (p<0.001 and antibiotics (p<0.05. At the final visit, there was a significant improvement in some measurements of asthma severity in group A (reduced unscheduled visits for ambulatory care, reduced treatment requirements for oral corticosteroids and antibiotics, reduced days off work, but a lack of statistical difference in lung function and the maintenance-inhaled corticosteroid dose. There was no significant change in group B. Conclusion. These results suggest that peak-flow based self management is more effective than traditonal treatment in mild and moderate persistent asthma. .
Saini, Bandana; LeMay, Kate; Emmerton, Lynne; Krass, Ines; Smith, Lorraine; Bosnic-Anticevich, Sinthia; Stewart, Kay; Burton, Deborah; Armour, Carol
To assess any improvements in knowledge of asthma patients after a tailored education program delivered by pharmacists and measure the sustainability of any improvements. To ascertain patients' perceptions about any changes in their knowledge. Ninety-six specially trained pharmacists recruited patients based on their risk of poor asthma control. A tailored intervention was delivered to patients based on individual needs and goals, and was conducted at three or four time points over six months. Asthma knowledge was assessed at the beginning and end of the service, and six and 12 months after it had ended. Patients' perceptions of the impact of the service on their knowledge were explored qualitatively in interviews. The 96 pharmacists recruited 570 patients, 398 (70%) finished. Asthma knowledge significantly improved as a result of the service (7.65 ± 2.36, n=561, to 8.78 ± 2.14, n=393). This improvement was retained for at least 12 months after the service. Patients reported how the knowledge and skills gained had led to a change in the way they managed their asthma. Improvements in knowledge are achievable and sustainable if pharmacists used targeted educational interventions. Pharmacist educational interventions are an efficient way to improve asthma knowledge in the community. Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All rights reserved.
Marcano Belisario, José S; Huckvale, Kit; Greenfield, Geva; Car, Josip; Gunn, Laura H
Asthma is one of the most common long-term conditions worldwide, which places considerable pressure on patients, communities and health systems. The major international clinical guidelines now recommend the inclusion of self management programmes in the routine management of patients with asthma. These programmes have been associated with improved outcomes in patients with asthma. However, the implementation of self management programmes in clinical practice, and their uptake by patients, is still poor. Recent developments in mobile technology, such as smartphone and tablet computer apps, could help develop a platform for the delivery of self management interventions that are highly customisable, low-cost and easily accessible. To assess the effectiveness, cost-effectiveness and feasibility of using smartphone and tablet apps to facilitate the self management of individuals with asthma. We searched the Cochrane Airways Group Register (CAGR), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Global Health Library, Compendex/Inspec/Referex, IEEEXplore, ACM Digital Library, CiteSeer(x) and CAB abstracts via Web of Knowledge. We also searched registers of current and ongoing trials and the grey literature. We checked the reference lists of all primary studies and review articles for additional references. We searched for studies published from 2000 onwards. The latest search was run in June 2013. We included parallel randomised controlled trials (RCTs) that compared self management interventions for patients with clinician-diagnosed asthma delivered via smartphone apps to self management interventions delivered via traditional methods (e.g. paper-based asthma diaries). We used standard methods expected by the Cochrane Collaboration. Our primary outcomes were symptom scores; frequency of healthcare visits due to asthma exacerbations or complications and health-related quality of life. We included two RCTs with a total of
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Scott, Lyne; Nichols, Breck; Choi Kwong, Kenny Yat; Morphew, Tricia; Jones, Craig A
To determine if patterns of predominant asthma disease activity are more closely related than baseline asthma severity to measures of morbidity (acute asthma attack, emergency room visit/hospitalization, missed school days, and/or steroid burst). Retrospective analysis was performed for inner-city Los Angeles asthmatic children (3 to 18 years of age) during their first year of enrollment in an asthma-specific disease management program. All measures of morbidity were more closely related to patterns of predominant disease activity than baseline severity. We conclude that patterns of predominant disease activity are a more significant predictor of asthma morbidity than is baseline severity.
Friedman, Deborah; Masek, Bruce; Barreto, Esteban; Baer, Lee; Lapey, Allen; Budge, Eduardo; McQuaid, Elizabeth L
To compare asthma care roles of maternal and paternal caregivers, and examine associations between caregiver involvement and the outcomes of adherence, morbidity, and parental quality of life (QoL). Mothers and fathers in 63 families of children, ages 5-9 years, with persistent asthma completed semistructured interviews and questionnaires. Adherence was measured via electronic monitoring. Paired t tests compared parental asthma care roles, and analysis of covariance, controlling for socioeconomic status, evaluated associations of asthma outcomes with caregiver involvement scores. Mothers had higher scores on measures of involvement, beliefs in medication necessity, and on four subscales of the Family Asthma Management System Scale interview (Asthma Knowledge, Relationship with Provider, Symptom Assessment, and Response to Symptoms). Maternal QoL was lowest when both maternal and paternal involvement was high. Paternal involvement was associated with increased morbidity. There is room for enhancement of fathers' asthma care roles. Higher levels of paternal involvement may be driven by family need. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: email@example.com.
Janevic, Mary R; Baptist, Alan P; Bryant-Stephens, Tyra; Lara, Marielena; Persky, Victoria; Ramos-Valencia, Gilberto; Uyeda, Kimberly; Hazan, Rebecca; Garrity, Ashley; Malveaux, Floyd J
Disparities by race and socioeconomic status persist in pediatric asthma morbidity, mortality, and treatment. Improving parent/provider communication and parents' asthma-management confidence may result in better asthma control in vulnerable populations. The Merck Childhood Asthma Network, Inc. funded an initiative to implement medical-social care coordination to improve asthma outcomes at sites in four low-income, urban communities (Los Angeles, CA; Philadelphia, PA; Chicago, IL; and San Juan, PR.) As part of a cross-site evaluation of this effort, pre- post-program changes in parents' reports of asthma care and management were assessed. Across sites, 805 parents or other caregivers responded to a baseline survey that was repeated one year later following their child's participation in care coordination. Parents' asthma-management confidence, as well as their perceptions of provider access, trust, and communication, were measured with Likert scales. Linear mixed models were used to assess improvement in these variables, across and within sites, adjusting for sociodemographics. Pooled across sites, the adjusted mean estimate for all outcomes showed a significant improvement (p asthma care coordination, as implemented variously in diverse settings, was associated with improvement in parents' perceptions of asthma care and self-reported asthma-management knowledge and confidence. This positive impact on parents may help sustain care coordination's impact on children.
Younis, M.; Anwar, S.; Aneela, I.; Saeed, M.S.
Background: Optimal asthma control in pregnant women is very much essential for the good health of both mother and the fetus. Maternal and fetal complications occur due to poor control of asthma. There are concerns that management of bronchial asthma in pregnant women should be optimal by the health professionals. Objective: The aim of the study was to evaluate the knowledge and practices of young female doctors about the bronchial asthma management in pregnancy. Study Design: Randomized evidence based. Study Setting: Punjab Public Service Commission (PPSC) interviews for women medical officers and female doctors working in different medical units and chest unit of Mayo Hospital a tertiary care hospital affiliated with King Edward Medical University, Lahore. Materials and Methods: A questionnaire based survey of knowledge and practices of one hundred and one female doctors in the management of bronchial asthma was made. Amongst these, 32 doctors were FCPS 1 in medicine and gynecology. Remaining 69 doctors were in the pipeline and they have completed one year house job in different specialties. The case scenario was Asthma management approach during pregnancy in a stable patient of moderate severity. Inclusion Criteria 1. All those female doctors who have completed one year house job. 2. Female doctors working in gynecology, medicine, surgery and allied specialties. Results: Overall 14 (13.6%) doctors (5 (35.7%) PGs and 9 (64.3%) Non PGs) have the standard prescription of inhaled corticosteroids with long acting inhaled B2 agonists and montelukast as controller medication and short acting inhaled B2 agonist as needed as reliever medication according to the standard guidelines. Conclusion: The majority of young female doctors had the suboptimal knowledge and practice of asthma management in pregnancy. We suggest initiating the training programs to optimize their knowledge and practices. (author)
Bronchial asthma is characterized by chronic airway inflammation. The primary goal of treatment of asthma is to maintain the state of control. According to the Japanese guidelines (JGL2012), long-term management consists of 4 therapeutic steps, and use of inhaled corticosteroids (ICS) is recommended at all 4 steps. Besides ICS, inhalation of long-acting β2-agonist (LABA) is also effective. Recently, omalizumab (a humanized antihuman IgE antibody) can be available for patients with severe allergic asthma. Although there is no specific strategy for preoperative treatment of patients with asthma, preoperative systemic steroid administration seemed to be effective to prevent asthma attack during anesthesia. The most common cause of chronic bronchitis is smoking. Even the respiratory function is within normal limits, perioperative management of patients with chronic bronchitis is often troublesome. The most common problem is their sputum. To minimize perioperative pulmonary complication in these patients, smoking cessation and pulmonary rehabilitation are essential. It is known that more than 1 month of smoking cessation is required to reduce perioperative respiratory complication. However, even one or two weeks of smoking cessation can decrease sputum secretion. In summary, preoperative optimization is most important to prevent respiratory complication in patients with bronchial asthma or chronic bronchitis.
Gharagozlou, Mohammad; Abdollahpour, Hengameh; Moinfar, Zahra; Bemanian, Mohammad Hassan; Sedaghat, Mojtaba
Asthma is one of the most common acute and chronic conditions in children, and the pediatricians are expected to provide an important role for asthma care in this age group, however there is no published information describing the different aspects of their practices about children asthma in Iran. This study was done to characterize the knowledge of the Iranian pediatricians about the diagnosis, treatment and education of asthma in children. Validated questionnaires were completed by 193 pediatricians from different parts of Iran during the International Congress of Pediatrics in Tehran. A total of 193 returned questionnaires (96.5%) were eligible for the survey and analysis. About 49% of the respondents were male and 18% were sub-specialists. Wheezing was the most common mentioned symptoms in taking asthma into consideration. About 40% of these physicians had no plan for doing spirometry in eligible children and 35.2% of them did not have familiarity with peak flowmeter. Also about 17.6% of them paid no regular visits to their asthmatic patients. Only 29% of the respondents indicated that they would prescribe inhaled corticosteroids for a 6-year-old child with moderate persistent asthma and 73.3% of them would prescribe inhaled bronchodilator (Salbutamol) for an acute asthmatic attack as the first drug, while 17.1% of them used epinephrine injection for this purpose. About 42.2% of the respondents did not consider any education or action plan for their patients and only 60.6% of them had access to standard guidelines and educational programs. The results show that there are numerous aspects of children asthma management in Iran which are not consistent with standardized guidelines and recommendations. This survey and the attained information suggest areas for interventions to improve the pediatricians' knowledge about asthma and the disease management.
Baur, X.; Aasen, T.B.; Burge, P.S.; Heederik, D.
The aim of the European Respiratory Society work-related asthma guidelines is to present the management and prevention options of work-related asthma and their effectiveness. Work-related asthma accounts for 5-25% of all adult asthma cases and is responsible for a significant socioeconomic burden.
Dec 2, 1994 ... A new severity grading of mild, modera~e and severe asthma is proposed to aid in the selection ot ... G. Stiles, J. Vermeulen, E. Weinberg (Chairperson). Report compiled by: D. K. luyt, R. J. Green and D. .... Cigarette smoking is harmful to asthmatics. Smoking should not be allowed in the home of any ...
Gupta, Ruchi S; Rivkina, Victoria; DeSantiago-Cardenas, Lilliana; Smith, Bridget; Harvey-Gintoft, Blair; Whyte, Stephanie A
This study aimed to characterize asthma and food allergy reporting and management in Chicago Public Schools. Demographic and health data for students who have asthma and food allergy were extracted from the Chicago Public Schools database. Demographic and geographic variability and the existence of school health management plans were analyzed, and multiple logistic regression models were computed. Home addresses were geocoded to create maps of case counts per community area. Approximately 18,000 asthmatic and 4000 food allergic students were identified. Of asthmatic students, 9.3% had a food allergy; of food allergic students, 40.1% had asthma. Asthma odds were significantly higher among black and Hispanic students (odds ratio [OR] = 2.3 and 1.3, respectively), whereas food allergy odds were significantly higher among black students (OR = 1.1; 95% confidence interval [CI], 1.0-1.3) and significantly lower among Hispanic students (OR = 0.8; 95% CI, 0.7-0.9). Only 24.3% of students who had asthma and 50.9% of students who had food allergy had a school health management plan on file. Odds of having a school health management plan were significantly higher among students with both conditions, but the likelihood of having a plan on file was significantly lower among racial/ethnic minority and low-income students, regardless of medical condition. Only 1 in 4 students who have asthma and half of food allergic students have health management plans in schools, with lower numbers among minority and low-income students. Improving chronic disease reporting and access to school health management plans is critical. Copyright © 2014 by the American Academy of Pediatrics.
Neil C. Thomson
Full Text Available Omalizumab, a humanized monoclonal antibody that binds circulating IgE antibody, is a treatment option for patients with moderate to severe allergic asthma whose asthma is poorly controlled with inhaled corticosteroids and inhaled long-acting β 2 agonist bronchodilators. This review considers the mechanism of action, pharmacokinetics, efficacy, safety and place in management of omalizumab in asthma and focuses particularly on key articles published over the last three years. Omalizumab reduces IgE mediated airway inflammation and its effect on airway remodeling is under investigation. Recent long-term clinical trials confirm the benefits of omalizumab in reducing exacerbations and symptoms in adults and in children with moderate to severe allergic asthma. No clinical or immunological factor consistently predicts a good therapeutic response to omalizumab in allergic asthma. In responders, the duration of treatment is unclear. The main adverse effect of omalizumab is anaphylaxis, although this occurs infrequently. Preliminary data from a five-year safety study has raised concerns about increased cardiovascular events and a final report is awaited. Clinical trials are in progress to determine whether omalizumab has efficacy in the treatment of non-allergic asthma.
Chotirmall, Sanjay Haresh
Despite comprehensive guidelines established by the European Global Initiative for Asthma and the U.S. National Asthma Education and Prevention Program on the diagnosis and management of asthma, its mortality in older adults continues to rise. Diagnostic and therapeutic problems contribute to older patients being inadequately treated. The diagnosis of asthma rests on the history and characteristic pulmonary function testing (PFT) with the demonstration of reversible airway obstruction, but there are unique problems in performing this test in older patients and in its interpretation. This review aims to address the difficulties in performing and interpreting PFT in older patients because of the effects of age-related changes in lung function on respiratory physiology. The concept of "airway remodeling" resulting in "fixed obstructive" PFT and the relevance of atopy in older people with asthma are assessed. There are certain therapeutic issues unique to older patients with asthma, including the increased probability of adverse effects in the setting of multiple comorbidities and issues surrounding effective drug delivery. The use of beta 2-agonist, anticholinergic, corticosteroid, and anti-immunoglobulin E treatments are discussed in the context of these therapeutic issues.
Horner, Sharon D; Brown, Adama
Most studies of childhood asthma management use data from a single family reporter and fail to capture the parent-child dyadic influences. In this descriptive exploratory study with 183 parent-child dyads, data were collected from both parents and children. Using structural equation modeling, the relationships of parents' and children's asthma knowledge, self-efficacy to manage asthma, and asthma management on the child's quality of life were examined. Direct significant relationships from knowledge to self-efficacy to asthma management were found for each member of the dyad. The associations between parents' and children's self-efficacy and asthma management were not statistically significant. Only the children's self-efficacy to manage asthma was significantly associated with children's asthma-related quality of life.
Full Text Available Abstract Background In the UK, people of South Asian origin with asthma experience excess morbidity, with hospitalisation rates three times those of the majority White population and evidence suggests that South Asian children with asthma are more likely to suffer uncontrolled symptoms and hospital admissions with acute asthma compared to White British children. This paper draws on data from The Management and Interventions for Asthma (MIA study to identify the operation of barriers to optimal care and good asthma control for South Asian children. Methods The MIA study followed a multi-phase, iterative, participatory design, underpinned by the socio-ecological model. Findings presented here are from face-to face, semi-structured interviews with South Asian (Indian, Pakistani and Bangladeshi origin parents and carers of a child with asthma (n = 49. Interviews were conducted in English or relevant South Asian languages using specially trained community facilitators. Data were transcribed verbatim and analysed according to the principles of interpretive thematic analysis, facilitated by the use of NVivo. Results Seven dimensions of candidacy are identified: identification of candidacy; navigation; the permeability of asthma services; appearances at health services; adjudications; offers and resistance and operating conditions in the local production of candidacy. The analysis demonstrates several ways in which a potential lack of alignment between the priorities and competencies of British South Asian families and the organization of health services combine to create vulnerabilities and difficulties in effectively managing childhood asthma. Conclusions Healthcare systems have a responsibility to develop services that are sensitive and appropriate to the needs of their communities. In South Asian communities, further efforts are required to raise awareness of symptoms and effectively communicate how, when and where to seek help for children
Hudson, Nicky; Culley, Lorraine; Johnson, Mark; McFeeters, Melanie; Robertson, Noelle; Angell, Emma; Lakhanpaul, Monica
In the UK, people of South Asian origin with asthma experience excess morbidity, with hospitalisation rates three times those of the majority White population and evidence suggests that South Asian children with asthma are more likely to suffer uncontrolled symptoms and hospital admissions with acute asthma compared to White British children. This paper draws on data from The Management and Interventions for Asthma (MIA) study to identify the operation of barriers to optimal care and good asthma control for South Asian children. The MIA study followed a multi-phase, iterative, participatory design, underpinned by the socio-ecological model. Findings presented here are from face-to face, semi-structured interviews with South Asian (Indian, Pakistani and Bangladeshi origin) parents and carers of a child with asthma (n = 49). Interviews were conducted in English or relevant South Asian languages using specially trained community facilitators. Data were transcribed verbatim and analysed according to the principles of interpretive thematic analysis, facilitated by the use of NVivo. Seven dimensions of candidacy are identified: identification of candidacy; navigation; the permeability of asthma services; appearances at health services; adjudications; offers and resistance and operating conditions in the local production of candidacy. The analysis demonstrates several ways in which a potential lack of alignment between the priorities and competencies of British South Asian families and the organization of health services combine to create vulnerabilities and difficulties in effectively managing childhood asthma. Healthcare systems have a responsibility to develop services that are sensitive and appropriate to the needs of their communities. In South Asian communities, further efforts are required to raise awareness of symptoms and effectively communicate how, when and where to seek help for children. There is a need for improved diagnosis and consistent, effectively
Lund, Thomas Kromann
. Elite athletes with physician-diagnosed asthma seem to have less airway reactivity and fewer sputum eosinophils than non-athletes with physician-diagnosed asthma, but more studies are needed to further investigate if and how the asthma phenotype of elite athletes differs from that of classical asthma....
Kamps, Arvid W. A.; Brand, PLP; Kimpen, JLL; Maille, AR; Overgoor-van de Groes, AW; van Helsdingen-Peek, LCJAM
Background: Until now, care provided by asthma nurses has been additional to care provided by paediatricians. A study was undertaken to compare nurse led outpatient management of childhood asthma with follow up by a paediatrician. Methods: Seventy four children referred because of insufficient
Arga, Mustafa; Bakirtas, Arzu; Catal, Ferhat; Derinoz, Oksan; Topal, Erdem; Demirsoy, M Sadik; Turktas, Ipek
To assess and compare management preferences of physicians for moderate and severe acute asthma based on case scenarios and to determine the factors influencing their decisions. A questionnaire based on the Global Initiative on Asthma (GINA) guideline and comprising eight questions on management of acute asthma was delivered to participants of two national pediatric congresses. Management of moderate and severe acute asthma cases was evaluated by two clinical case scenarios for estimation of acute attack severity, initial treatment, treatment after 1h, and discharge recommendations. A uniform answer box comprising the possible choices was provided just below the questions, and respondents were requested to tick the answers they thought was appropriate. Four-hundred and eighteen questionnaires were analyzed. All questions regarding moderate and severe acute asthma case scenarios were answered accurately by 15.8% and 17.0% of physicians, respectively. The initial treatment of moderate and severe cases was known by 100.0% and 78.2% of physicians, respectively. Knowledge of the appropriate plan for treatment after 1h was low both for moderate (45.0%) and severe attacks (35.4%). Discharge recommendations were adequate in 32.5% and 70.8% of physicians for moderate and severe attacks, respectively. Multiple logistic regression analysis revealed that working at a hospital with a continuing medical education program was the only significant predictor of a correct response to all questions regarding severe attacks (p = .04; 95%CI, 1.02-3.21). No predictors were found for information on moderate attacks. Pediatricians have difficulty in planning treatment after 1 hour both for moderate and severe asthma attacks. Postgraduate education programs that target physicians in hospitals without continuing medical education facilities may improve guideline adherence.
Quirce, Santiago; Diaz-Perales, Araceli
Grain-induced asthma is a frequent occupational allergic disease mainly caused by inhalation of cereal flour or powder. The main professions affected are bakers, confectioners, pastry factory workers, millers, farmers, and cereal handlers. This disorder is usually due to an IgE-mediated allergic response to inhalation of cereal flour proteins. The major causative allergens of grain-related asthma are proteins derived from wheat, rye and barley flour, although baking additives, such as fungal α-amylase are also important. This review deals with the current diagnosis and treatment of grain-induced asthma, emphasizing the role of cereal allergens as molecular tools to enhance diagnosis and management of this disorder. Asthma-like symptoms caused by endotoxin exposure among grain workers are beyond the scope of this review. Progress is being made in the characterization of grain and bakery allergens, particularly cereal-derived allergens, as well as in the standardization of allergy tests. Salt-soluble proteins (albumins plus globulins), particularly members of the α-amylase/trypsin inhibitor family, thioredoxins, peroxidase, lipid transfer protein and other soluble enzymes show the strongest IgE reactivities in wheat flour. In addition, prolamins (not extractable by salt solutions) have also been claimed as potential allergens. However, the large variability of IgE-binding patterns of cereal proteins among patients with grain-induced asthma, together with the great differences in the concentrations of potential allergens observed in commercial cereal extracts used for diagnosis, highlight the necessity to standardize and improve the diagnostic tools. Removal from exposure to the offending agents is the cornerstone of the management of grain-induced asthma. The availability of purified allergens should be very helpful for a more refined diagnosis, and new immunomodulatory treatments, including allergen immunotherapy and biological drugs, should aid in the management
Sep 14, 2017 ... a major health issue in many developing countries due to increasing air pollution, fast modernization, widespread construction work, westernized diet, improved living standards, and more dust mites.. In recent years, there has been a remarkable improvement in the management of asthma due to the ...
Goonan, K J; Healy, J M; Jordan, H S; Zazzali, J L; Horowitz, M
This strategic plan translates the HCHP vision statement into a working plan for one major clinical condition--asthma in children. It is a working plan for clinicians and managers across specialties and levels. The results of the projects will improve in a measurable way significant clinical practice and outcomes, in keeping with the FY 1993 strategic goals.
Olivera, Carolina M. X.; Vianna, Elcio Oliveira; Bonizio, Roni C.; de Menezes, Marcelo B.; Ferraz, Erica; Cetlin, Andrea A.; Valdevite, Laura M.; Almeida, Gustavo A.; Araujo, Ana S.; Simoneti, Christian S.; de Freitas, Amanda; Lizzi, Elisangela A.; Borges, Marcos C.; de Freitas, Osvaldo
Information for patients provided by the pharmacist is reflected in adhesion to treatment, clinical results and patient quality of life. The objective of this study was to assess an asthma self-management model for rational medicine use. This was a randomized controlled trial with 60 asthmatic patients assigned to attend five modules presented by…
Turyk, Mary; Banda, Elizabeth; Chisum, Gay; Weems, Dolores; Liu, Yangyang; Damitz, Maureen; Williams, Rhonda; Persky, Victoria
Home-based, multifaceted interventions have been effective in reducing asthma morbidity in children. However, identification of independent components that contribute to outcomes and delineating effectiveness by level of asthma symptoms would help to refine the intervention and target appropriate populations. A community health educator led asthma intervention implemented in a low-income African-American neighborhood included asthma management education, individually tailored low-cost asthma home trigger remediation, and referrals to social and medical agencies, when appropriate. Changes in asthma morbidity measures were assessed in relation to implementation of individual intervention components using multivariable logistic regression. Among the 218 children who completed the year-long program, there were significant reductions in measures of asthma morbidity, including symptoms, urgent care visits, emergency department (ED) visits, hospitalizations, missed school days, and missed work days for caretakers. We also found significant decreases in the prevalence of many home asthma triggers and improvements in asthma management practices. Improvement in caretaker's ability to manage the child's asthma was associated with reduction in ED visits for asthma and uncontrolled asthma. Specific home interventions, such as repair of water leaks and reduced exposure to plants, dust, clutter and stuffed toys, may be related to reduction in asthma morbidity. This program was effective in reducing asthma morbidity in low-income African-American children and identified specific interventions as possible areas to target in future projects. Furthermore, the intervention was useful in children with persistent asthma symptoms as well as those with less frequent asthma exacerbations.
Bart L. Rottier
Full Text Available Management-related issues are an important aspect of monitoring asthma in children in clinical practice. This review summarises the literature on practical aspects of monitoring including adherence to treatment, inhalation technique, ongoing exposure to allergens and irritants, comorbid conditions and side-effects of treatment, as agreed by the European Respiratory Society Task Force on Monitoring Asthma in Childhood. The evidence indicates that it is important to discuss adherence to treatment in a non-confrontational way at every clinic visit, and take into account a patient's illness and medication beliefs. All task force members teach inhalation techniques at least twice when introducing a new inhalation device and then at least annually. Exposure to second-hand tobacco smoke, combustion-derived air pollutants, house dust mites, fungal spores, pollens and pet dander deserve regular attention during follow-up according to most task force members. In addition, allergic rhinitis should be considered as a cause for poor asthma control. Task force members do not screen for gastro-oesophageal reflux and food allergy. Height and weight are generally measured at least annually to identify individuals who are susceptible to adrenal suppression and to calculate body mass index, even though causality between obesity and asthma has not been established. In cases of poor asthma control, before stepping up treatment the above aspects of monitoring deserve closer attention.
D'Souza, W; Burgess, C; Ayson, M; Crane, J; Pearce, N; Beasley, R
The "credit card" asthma self-management plan provides the adult asthmatic patient with simple guidelines for the self-management of asthma, which are based on the self-assessment of peak expiratory flow rate recordings and symptoms. The study was a trial of the clinical efficacy of the credit card plan in a high-risk group of asthmatic patients. In this "before-and-after" trial, patients discharged from the emergency department of Wellington Hospital, after treatment for severe asthma were invited to attend a series of hospital outpatient clinics at which the credit card plan was introduced. Questionnaires were used to compare markers of asthma morbidity, requirement for emergency medical care, and medication use during the 6-month period before and after intervention with the credit card plan. Of the 30 patients with asthma who attended the first outpatient clinic, 26 (17 women and 9 men) completed the program. In these 26 participants, there was a reduction in both morbidity and requirement for acute medical services: specifically, the proportion waking with asthma more than once a week decreased from 65% to 23% (p = 0.005) and the proportion visiting the emergency department for treatment of severe asthma decreased from 58% to 15% (p = 0.004). The patients attending the clinics commented favorably on the plan, in particular on its usefulness as an educational tool for monitoring and treating their asthma. Although the interpretation of this study is limited by the lack of a randomized control group, the findings are consistent with other evidence that the credit card asthma self-management plan can be an effective and acceptable system for improving asthma care in a high-risk group of adult patients with asthma.
Beck, Andrew F; Huang, Bin; Wheeler, Kathryn; Lawson, Nikki R; Kahn, Robert S; Riley, Carley L
To determine whether the Child Opportunity Index (COI), a nationally available measure of relative educational, health/environmental, and social/economic opportunity across census tracts within metropolitan areas, is associated with population- and patient-level asthma morbidity. This population-based retrospective cohort study was conducted between 2011 and 2013 in a southwest Ohio county. Participants included all children aged 1-16 years with hospitalizations or emergency department visits for asthma or wheezing at a major pediatric hospital. Patients were identified using discharge diagnosis codes and geocoded to their home census tract. The primary population-level outcome was census tract asthma hospitalization rate. The primary patient-level outcome was rehospitalization within 12 months of the index hospitalization. Census tract opportunity was characterized using the COI and its educational, health/environmental, and social/economic domains. Across 222 in-county census tracts, there were 2539 geocoded hospitalizations. The median asthma-related hospitalization rate was 5.0 per 1000 children per year (IQR, 1.9-8.9). Median hospitalization rates in very low, low, moderate, high, and very high opportunity tracts were 9.1, 7.6, 4.6, 2.1, and 1.8 per 1000, respectively (P asthma morbidity. The details provided by the COI may inform interventions aimed at increasing opportunity and reducing morbidity across regions. Copyright © 2017 Elsevier Inc. All rights reserved.
Brazil, Kevin; McLean, Leslie; Abbey, David; Musselman, Carol
Differences in asthma management among families with a child who has moderate to severe asthma were examined when they participated in an in-patient versus a day-camp program. Two broad categories of outcome were examined: illness and self-management skills. Findings and observations regarding children's feelings about asthma are discussed.…
Ali, Zarqa; Norsk, Peter; Ulrik, Charlotte Suppli
Asthma is often reported by elite athletes, especially endurance athletes. The aim of this article is to review current knowledge of mechanisms and management of exercise-induced asthma (EIA) in adult elite athletes.......Asthma is often reported by elite athletes, especially endurance athletes. The aim of this article is to review current knowledge of mechanisms and management of exercise-induced asthma (EIA) in adult elite athletes....
Backer, V; Ulrik, Charlotte Suppli; Harving, H
Suboptimal asthma control may be caused by a combination of factors, such as nonadherence to guidelines, lack of compliance, and poor asthma education. The aim was to assess patients' knowledge of asthma and different management strategies, including patients' attitudes toward involvement...... of uncontrolled disease with night asthma (16%), daily symptoms (18%), or exercise-induced asthma (11%) were found. Of 285 participants with persistent asthma, 70% used inhaled corticosteroids. Lung function was measured within the preceding 6 months in 24% of patients, whereas 7% had never had their lung...
Backer, Vibeke; Ulrik, Charlotte S.; Harving, Henrik
Suboptimal asthma control may be caused by a combination of factors, such as nonadherence to guidelines, lack of compliance, and poor asthma education. The aim was to assess patients' knowledge of asthma and different management strategies, including patients' attitudes toward involvement...... of uncontrolled disease with night asthma (16%), daily symptoms (18%), or exercise-induced asthma (11%) were found. Of 285 participants with persistent asthma, 70% used inhaled corticosteroids. Lung function was measured within the preceding 6 months in 24% of patients, whereas 7% had never had their lung...
Al-Moamary, Mohamed S.; Alhaider, Sami A.; Idrees, Majdy M.; Al Ghobain, Mohammed O.; Zeitouni, Mohammed O.; Al-Harbi, Adel S.; Yousef, Abdullah A.; Al-Matar, Hussain; Alorainy, Hassan S.; Al-Hajjaj, Mohamed S.
This is an updated guideline for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan. PMID:26933455
Barrecheguren, Miriam; Esquinas, Cristina; Miravitlles, Marc
Some individuals share characteristics of asthma and chronic obstructive pulmonary disease (COPD). The asthma-COPD overlap syndrome (ACOS) has been defined as symptoms of increased variability of airflow in association with an incompletely reversible airflow obstruction. In this review, we present the latest findings in the diagnosis, characterization and management of ACOS. Around 15-20% of COPD patients may have an ACOS. Patients with ACOS are characterized by increased reversibility of airflow obstruction, eosinophilic bronchial and systemic inflammation, and increased response to inhaled corticosteroids, compared with the remaining patients with COPD. Patients with ACOS have more frequent exacerbations, more wheezing and dyspnoea, but similar cough and sputum production compared with COPD. The relevance of the ACOS is to identify patients with COPD who may have underlying eosinophilic inflammation that responds to inhaled corticosteroids. So far, the previous diagnosis of asthma in a patient with COPD is the more reliable criterion for ACOS. Ongoing studies will clarify if concentrations of blood eosinophils may be useful to identify this subgroup of patients with COPD. If this is the case, the interest of ACOS may shift to that of eosinophilic COPD, which is easier to diagnose and has clear therapeutic implications.
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Patel, A M
The ultimate goals of managing asthma are to eliminate death, prevent or promptly treat exacerbations, and maximize the quality of life and health status of patients. Current strategies include appropriate education, trigger control, and timely access to effective pharmacotherapy and follow-up. Internet-based technologies have emerged as potentially powerful tools to enable meaningful communication and proactive partnership in care for various medical conditions. The main types of Internet-based applications for asthma management include remote monitoring and feedback between health professionals and their patients; online education and marketing for either patients or professionals; networking and collaborative research; and administrative oversight through policy making, planning, and decision support. With increased understanding of integrated disease management and the technostructural as well as psychodynamic issues related to Internet use, further refinement and evolution of the Internet and related technologies may drastically improve the way we monitor, educate, treat, and establish policies for this global problem while attending to individual or local community needs. This review presents a conceptual overview of the current challenges and use of the Internet for improving asthma management through timely and tailored education and appropriate access to health care expertise.
Schneider, Tali; Panzera, Anthony D; Couluris, Marisa; Lindenberger, James; McDermott, Robert; Bryant, Carol A
Despite the growing market of e-health disease self-management tools, few studies have reported the presence of teen patients in all phases of product design. While rates of American teens using mobile Internet grow, an opportunity to deliver disease self-management targeted for teen patients exists. Building on findings from previous investigations with teens with asthma, we explored teens' insights on the development of a patient-centered asthma management application (app). Two existing asthma apps were used by 16 teen asthmatics for 7-10 days. At the end of the trial period, in-depth interviews were conducted with each participant to gather insights about the user experience. Participants requested more asthma-related content that educates them about their condition. Suggested improvements to currently available apps included a longer list of selectable symptoms to track, medication tracking, and more compelling interface features. Participants showed interest in using apps for managing their asthma, yet recommended improvements on current design. Whereas national figures point to a more ubiquitous mobile device environment, implementation efforts must respond to participants' recommendations while minding lingering digital divides. Currently available apps lack appealing components that teens seek or desire. Subsequent development should include teens' participation in component design insights.
Eley, Robert; Gorman, Don
Context: Asthma affects over 15% of Australian Aboriginal people. Compliance in asthma management is poor. Interventions that will increase compliance are required. Purpose: The purpose of the study was to determine whether Aboriginal children, adolescents and adults would engage in music lessons to increase their knowledge of asthma and support…
Levy, Mark L; Thomas, Mike; Small, Iain; Pearce, Linda; Pinnock, Hilary; Stephenson, Paul
The 2008 BTS/SIGN British Guideline on the management of asthma provides comprehensive updated evidence-based guidance on asthma management for healthcare professionals. This primary care-focussed summary has been produced to aid dissemination and implementation of the key guideline messages into primary care. The section on diagnosis emphasises the new integrated symptom-based approach with clinicians using their deductive skills to determine the probability that the patient has asthma. The various tools used for monitoring asthma are discussed. There are sections on both non-pharmacological and pharmacological management of chronic asthma in adults and children. Treatment options for children are subdivided into the under-5s and children aged 5-12 years. Poor asthma control is manifested by exacerbations and acute asthma. Personalised asthma action plans for guided self management should be provided and used when levels of asthma control change. There are sections on difficult asthma and the treatment of exacerbations and acute severe asthma. Various outcome measures for auditing the quality of asthma care are discussed.
... asthma worse. If so, try to limit time outdoors when the levels of these substances in the outdoor air are high. If animal fur triggers your ... have side effects. Most doctors agree that the benefits of taking inhaled ... have. Also, work with your health care team if you have any questions about ...
Patients who continue to have symptoms with frequent attacks of asthma despite being adherent to treatment with multiple asthma medications, have severe asthma. Severe asthma has significant implications for the affected individual and utilise a disproportionate share of the health care costs associated with asthma.
Bereznicki, Bonnie J; Peterson, Gregory M; Jackson, Shane L; Walters, E Haydn; Fitzmaurice, Kimbra D; Gee, Peter R
To use community pharmacy medication records to identify patients whose asthma may not be well managed and then implement and evaluate a multidisciplinary educational intervention to improve asthma management. We used a multisite controlled study design. Forty-two pharmacies throughout Tasmania ran a software application that "data-mined" medication records, generating a list of patients who had received three or more canisters of inhaled short-acting beta(2)-agonists in the preceding 6 months. The patients identified were allocated to an intervention or control group. Pre-intervention data were collected for the period May to November 2006 and post-intervention data for the period December 2006 to May 2007. Intervention patients were contacted by the community pharmacist via mail, and were sent educational material and a letter encouraging them to see their general practitioner for an asthma management review. Pharmacists were blinded to the control patients' identities until the end of the post-intervention period. Dispensing ratio of preventer medication (inhaled corticosteroids [ICSs]) to reliever medication (inhaled short-acting beta(2)-agonists). Thirty-five pharmacies completed the study, providing 702 intervention and 849 control patients. The intervention resulted in a threefold increase in the preventer-to-reliever ratio in the intervention group compared with the control group (P < 0.01) and a higher proportion of patients in the intervention group using ICS therapy than in the control group (P < 0.01). Community pharmacy medication records can be effectively used to identify patients with suboptimal asthma management, who can then be referred to their GP for review. The intervention should be trialled on a national scale to determine the effects on clinical, social, emotional and economic outcomes for people in the Australian community, with a longer follow-up to determine sustainability of the improvements noted.
Henry H. Webster
The Pennsylvania Department of Forests and Waters serves the people in managing state forest lands and in helping private owners manage their forest lands. To produce more timber from Pennsylvania forests, the Department applies many different forestry practices. But the more effort it spends in one direction, the less it can spend in others. So the Department must...
Schifano, Elizabeth D; Hollenbach, Jessica P; Cloutier, Michelle M
To examine the concordance between spirometry and asthma symptoms in assessing asthma severity and beginning therapy by the general pediatrician. Between 2008 and 2012, spirometry testing was satisfactorily performed in 894 children (ages 5-19 years) whose asthma severity had been determined by their pediatrician using asthma guideline-based clinical criteria. Spirometry-determined asthma severity using national asthma guidelines and clinician-determined asthma severity were compared for concordance using weighted Kappa coefficients. Thirty percent of participants had clinically determined intermittent asthma; 32%, 33%, and 5% had mild, moderate, and severe, persistent asthma, respectively. Increasing disease severity was associated with decreases in the forced expiratory volume in 1 second/forced vital capacity (FVC) ratio (P spirometry-determined severity. Concordance was 0.16 (95% CI 0.10, 0.23), and when adjusted for bias and prevalence, was 0.20 (95% CI 0.17, 0.23). When accounting for age, sex, exposure to smoke, and insurance type, only spirometry-determined asthma severity was a significant predictor of agreement (P spirometry-determined severity increased. Concordance between spirometry and asthma symptoms in determining asthma severity is low even when guideline-based clinical assessment tools are used. Because appropriate therapy reduces asthma morbidity and is guided by disease severity, results from spirometry testing could better guide pediatricians in determining appropriate therapy for their patients with asthma. Copyright © 2014 Elsevier Inc. All rights reserved.
Pett, Ryan G; Nye, Shane
To observe whether American Indian and Alaskan Native (AI/AN) patients at the Yakama Indian Health Service seen at the pharmacist-managed asthma clinic improved asthma outcomes. Retrospective chart review, single group, preintervention and postintervention. Pharmacist-managed asthma clinic at an Indian Health Service ambulatory care clinic. Sixty-one AI/AN patients who were seen at least once in the asthma clinic from 2010 to 2014. Pharmacist-provided asthma education and medication management. Asthma-related hospitalizations and emergency department or urgent care (ED) visits. The total number of asthma-related hospitalizations and ED visits between the 12-month periods preceding and following the initial asthma clinic visit were 11 versus 2 hospitalizations (P = 0.02) and 43 versus 25 ED visits (P = 0.02), respectively. Over the same period, asthma-related oral corticosteroid use showed a nonsignificant decrease in the number of prescriptions filled (n = 59, P = 0.08). In contrast, inhaled corticosteroid prescription fills significantly increased (n = 42, P = 0.01). A reduction of asthma-related hospitalizations and ED visits were observed during the course of the intervention. Increased access to formal asthma education and appropriate asthma care benefit the Yakama AI/AN people. A controlled trial is needed to confirm that the intervention causes the intended effect. Published by Elsevier Inc.
Boulet, Louis-Philippe; Dorval, E; Labrecque, M; Turgeon, M; Montague, T; Thivierge, R L
Asthma care in Canada and around the world persistently falls short of optimal treatment. To optimize care, a systematic approach to identifying such shortfalls or 'care gaps', in which all stakeholders of the health care system (including patients) are involved, was proposed. Several projects of a multipartner, multidisciplinary disease management program, developed to optimize asthma care in Quebec, was conducted in a period of eight years. First, two population maps were produced to identify regional variations in asthma-related morbidity and to prioritize interventions for improving treatment. Second, current care was evaluated in a physician-patient cohort, confirming the many care gaps in asthma management. Third, two series of peer-reviewed outcome studies, targeting high-risk populations and specific asthma care gaps, were conducted. Finally, a process to integrate the best interventions into the health care system and an agenda for further research on optimal asthma management were proposed. Key observations from these studies included the identification of specific patterns of noncompliance in using inhaled corticosteroids, the failure of increased access to spirometry in asthma education centres to increase the number of education referrals, the transient improvement in educational abilities of nurses involved with an asthma hotline telephone service, and the beneficial effects of practice tools aimed at facilitating the assessment of asthma control and treatment needs by general practitioners. Disease management programs such as Towards Excellence in Asthma Management can provide valuable information on optimal strategies for improving treatment of asthma and other chronic diseases by identifying care gaps, improving guidelines implementation and optimizing care.
Lin, Ching-Hsiung; Cheng, Shih-Lung
Despite the expansion of the understanding in asthma pathophysiology and the continual advances in disease management, a small subgroup of patients remain partially controlled or refractory to standard treatments. Upon the identification of immunoglobulin E and other inflammatory mediators, investigations and developments of targeted agents have thrived. Omalizumab is a humanized monoclonal antibody that specifically targets the circulating immunoglobulin E, which in turn impedes and reduces subsequent releases of the proinflammatory mediators. In the past decade, omalizumab has been proven to be efficacious and well-tolerated in the treatment of moderate-to-severe asthma in both trials and real-life studies, most notably in reducing exacerbation rates and corticosteroid use. While growing evidence has demonstrated that omalizumab may be potentially beneficial in treating other allergic diseases, its indication remains confined to treating severe allergic asthma and chronic idiopathic urticaria. Future efforts may be focused on determining the optimal length of omalizumab treatment, seeking biomarkers that could better predict treatment response, as well as extending its indications.
Full Text Available Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child.
Full Text Available Ching-Hsiung Lin,1–3 Shih-Lung Cheng4,5 1Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, Republic of China; 2Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan, Republic of China; 3School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China; 4Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan, Republic of China; 5Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli City, Taoyuan County, Taiwan, Republic of China Abstract: Despite the expansion of the understanding in asthma pathophysiology and the continual advances in disease management, a small subgroup of patients remain partially controlled or refractory to standard treatments. Upon the identification of immunoglobulin E and other inflammatory mediators, investigations and developments of targeted agents have thrived. Omalizumab is a humanized monoclonal antibody that specifically targets the circulating immunoglobulin E, which in turn impedes and reduces subsequent releases of the proinflammatory mediators. In the past decade, omalizumab has been proven to be efficacious and well-tolerated in the treatment of moderate-to-severe asthma in both trials and real-life studies, most notably in reducing exacerbation rates and corticosteroid use. While growing evidence has demonstrated that omalizumab may be potentially beneficial in treating other allergic diseases, its indication remains confined to treating severe allergic asthma and chronic idiopathic urticaria. Future efforts may be focused on determining the optimal length of omalizumab treatment, seeking biomarkers that could better predict treatment response, as well as extending its indications. Keywords: severe asthma, IgE, omalizumab, exacerbation, chronic idiopathic urticarial, inhaled corticosteroid
Ahmed, Sara; Ernst, Pierre; Bartlett, Susan J; Valois, Marie-France; Zaihra, Tasneem; Paré, Guy; Grad, Roland; Eilayyan, Owis; Perreault, Robert; Tamblyn, Robyn
Whether Web-based technologies can improve disease self-management is uncertain. My Asthma Portal (MAP) is a Web-based self-management support system that couples evidence-based behavioral change components (self-monitoring of symptoms, physical activity, and medication adherence) with real-time monitoring, feedback, and support from a nurse case manager. The aim of this study was to compare the impact of access to a Web-based asthma self-management patient portal linked to a case-management system (MAP) over 6 months compared with usual care on asthma control and quality of life. A multicenter, parallel, 2-arm, pilot, randomized controlled trial was conducted with 100 adults with confirmed diagnosis of asthma from 2 specialty clinics. Asthma control was measured using an algorithm based on overuse of fast-acting bronchodilators and emergency department visits, and asthma-related quality of life was assessed using the Mini-Asthma Quality of Life Questionnaire (MAQLQ). Secondary mediating outcomes included asthma symptoms, depressive symptoms, self-efficacy, and beliefs about medication. Process evaluations were also included. A total of 49 individuals were randomized to MAP and 51 to usual care. Compared with usual care, participants in the intervention group reported significantly higher asthma quality of life (mean change 0.61, 95% CI 0.03 to 1.19), and the change in asthma quality of life for the intervention group between baseline and 3 months (mean change 0.66, 95% CI 0.35 to 0.98) was not seen in the control group. No significant differences in asthma quality of life were found between the intervention and control groups at 6 (mean change 0.46, 95% CI -0.12 to 1.05) and 9 months (mean change 0.39, 95% CI -0.2 to 0.98). For poor control status, there was no significant effect of group, time, or group by time. For all self-reported measures, the intervention group had a significantly higher proportion of individuals, demonstrating a minimal clinically
Katwa, Umakanth; Rivera, Estefania
Asthma is the most common chronic pediatric condition. Effective asthma management requires a proactive and inclusive approach that controls the patient's symptoms and prevents recurrence of exacerbations. Clinicians should encourage patients to become involved in their management since self-management approaches have proven to be an effective means for chronic illness treatment. Novel forms of self-monitoring and management are technological interventions. In the last decade, novel technology has been developed and used to improve asthma control since it is a powerful agent that addresses a variety of challenges in chronic disease management such as education, communication and adherence. A myriad of technology-based strategies are available although many of these are not evidence based and further studies are needed to evaluate their efficacy in specific asthma-control endpoints. Herein, authors present a review of current and future technology-based options for asthma management and a comparison between them.
Lim, Angelina; Stewart, Kay; Abramson, Michael J; Walker, Susan P; George, Johnson
Uncontrolled asthma during pregnancy is associated with the maternal hazards of disease exacerbation, and perinatal hazards including intrauterine growth restriction and preterm birth. Interventions directed at achieving better asthma control during pregnancy should be considered a high priority in order to optimise both maternal and perinatal outcomes. Poor compliance with prescribed asthma medications during pregnancy and suboptimal prescribing patterns to pregnant women have both been shown to be contributing factors that jeopardise asthma control. The aim is to design and evaluate an intervention involving multidisciplinary care for women experiencing asthma in pregnancy. A pilot single-blinded parallel-group randomized controlled trial testing a Multidisciplinary Approach to Management of Maternal Asthma (MAMMA©) which involves education and regular monitoring. Pregnant women with asthma will be recruited from antenatal clinics in Victoria, Australia. Recruited participants, stratified by disease severity, will be allocated to the intervention or the usual care group in a 1:1 ratio. Both groups will be followed prospectively throughout pregnancy and outcomes will be compared between groups at three and six months after recruitment to evaluate the effectiveness of this intervention. Outcome measures include Asthma Control Questionnaire (ACQ) scores, oral corticosteroid use, asthma exacerbations and asthma related hospital admissions, and days off work, preventer to reliever ratio, along with pregnancy and neonatal adverse events at delivery. The use of FEV(1)/FEV(6) will be also investigated during this trial as a marker for asthma control. If successful, this model of care could be widely implemented in clinical practice and justify more funding for support services and resources for these women. This intervention will also promote awareness of the risks of poorly controlled asthma and the need for a collaborative, multidisciplinary approach to asthma
Boluyt, Nicole; van der Lee, Johanna H.; Moyer, Virginia A.; Brand, Paul L. P.; Offringa, Martin
OBJECTIVE: Our goal was to evaluate clinical, methodologic, and reporting aspects of systematic reviews on the management of acute asthma in children. METHODS: We undertook a systematic review of systematic reviews on acute asthma management in children. We identified eligible reviews by searching
Kovačević, Milena; Ćulafić, Milica; Jovanović, Marija; Vučićević, Katarina; Kovačević, Sandra Vezmar; Miljković, Branislava
Asthma self-management is aimed to improve the quality and effectiveness of asthma care by supporting the patients to manage their illness by themselves. The aim of the study was to evaluate the impact of pharmacist-delivered counselling on patients knowledge and beliefs about the medicines, adherence level, and asthma control. A prospective intervention study was conducted in community pharmacies. A total of 90 patients completed the study. Four questionnaires were used: (1) Beliefs about medicines questionnaire (BMQ), (2) Knowledge of asthma and asthma medicine (KAM), (3) Asthma control test (ACT), and (4) 8-item Morisky medication adherence scale questionnaire (MMAS-8). Questionnaires were completed at baseline and 3 months later. Low level of adherence and poor asthma control were determined initially. Better asthma control was significantly associated with higher adherence level, lower concerns regarding the medication use, and knowledge of triggers. Statistically significant improvement was found after 3 months in patients knowledge of asthma and its medications, their attitude towards medications (decrease in harm, overuse and concern; increase in necessity score), asthma control score (increased from 19 to 20, p < 0.05) and level of adherence (MMAS-8 score decreased from 3 to 2 p < 0.05). Better asthma control was achieved in 60% of patients. Sixteen patients (18%) were transferred from poor to well-controlled asthma, implying no need for patients' referral to the doctor and no additional cost for the health system. Improved disease control could be a result of enhanced knowledge and understanding of the disease-medication relationship, improved inhalation technique, and support on patients' adherence. Acquired knowledge and skills, as well as improved attitude, empowered patients to take a more active part in asthma management. Education in further patients' follow-up should consider topics tailored to the patients' characteristics, needs, and prior
Gibson, Peter G; McDonald, Vanessa M
Severe asthma is a complex heterogeneous disease that is refractory to standard treatment and is complicated by multiple comorbidities and risk factors. In mild to moderate asthma, the burden of disease can be minimised by inhaled corticosteroids, bronchodilators and self-management education. In severe asthma, however, management is more complex. When patients with asthma continue to experience symptoms and exacerbations despite optimal management, severe refractory asthma (SRA) should be suspected and confirmed, and other aetiologies ruled out. Once a diagnosis of SRA is established, patients should undergo a systematic and multidimensional assessment to identify inflammatory endotypes, risk factors and comorbidities, with targeted and individualised management initiated. We describe a practical approach to assessment and management of patients with SRA. © 2017 Royal Australasian College of Physicians.
Tarlo, Susan M; Arif, Ahmed A; Delclos, George L; Henneberger, Paul; Patel, Jenil
Occupational asthma (OA), a common respiratory disorder in Western countries, is caused by exposures at the workplace. It is part of a broader definition of work-related asthma (WRA) that also includes pre-existing asthma aggravated by substances present in the workplace environment, and it is potentially preventable. The purpose of this paper is to illustrate preventive measures for occupational asthma by case studies. In three case studies we discuss preventive measures that have been associated with reductions in incidence of occupational asthma from natural rubber latex and from diisocyanates as supported by published literature. We also discuss challenges in relation to asthma from cleaning products in healthcare work. Several preventive measures have been associated with reduction in incidence of occupational asthma from natural rubber latex and from diisocyanates, and may provide lessons for prevention of other causes of occupational asthma. Cleaning products remain an unresolved problem at present with respect to asthma risks but potential measures include the use of safer products and safer applications such as avoidance of spray products, use of occupational hygiene methods such as improving local ventilation, and when appropriate, the use of personal protective devices. Copyright © 2017 Elsevier Inc. All rights reserved.
Baarnes, Camilla Boslev; Hansen, A V; Ulrik, Charlotte Suppli
BACKGROUND: Poor adherence with inhaled corticosteroids (ICS) is a major problem in asthma and according to previous studies not least during pregnancy. OBJECTIVE: Our aim was to assess if enrolment in an asthma management program, and by that close monitoring, can improve self-reported and docum......BACKGROUND: Poor adherence with inhaled corticosteroids (ICS) is a major problem in asthma and according to previous studies not least during pregnancy. OBJECTIVE: Our aim was to assess if enrolment in an asthma management program, and by that close monitoring, can improve self......-reported and documented adherence with ICS in pregnant women with asthma. METHODS: Pregnant women with doctor-diagnosed asthma, currently being prescribed ICS, referred during a 12-month period to the outpatient respiratory clinic, were consecutively included in the study. They had follow-up visits every 4 weeks during...
Richards, Levi B.; Neerincx, Anne H.; van Bragt, Job J. M. H.; Sterk, Peter J.; Bel, Elisabeth H. D.; Maitland-van der Zee, Anke H.
Asthma features a high degree of heterogeneity in both pathophysiology and therapeutic response, resulting in many asthma patients being treated inadequately. Biomarkers indicative of underlying pathological processes could be used to identify disease subtypes, determine prognosis and to predict or
ficult for health providers to adhere to international guidelines. The purpose of this review ... salbutamol administration increases the likelihood of asthma. At diagnosis ... or with exercise) and chest tightness should be evaluat- ed for asthma.2 ...
Sep 14, 2017 ... the participants regarding knowledge of asthma prevalence, asthma risk factors, and ..... pneumonia which are known to be more common among low birth weight ... poor symptom control and frequent exacerbations. The.
Türktaş, Haluk; Bavbek, Sevim; Misirligil, Zeynep; Gemicioğlu, Bilun; Mungan, Dilşad
To evaluate patient characteristics and practice patterns in the management of acute asthma attack at tertiary care centers across Turkey. A total of 294 patients (mean age: 50.4 ± 15.1 years; females: 80.3%) diagnosed with persistent asthma were included in this retrospective study upon their admission to the hospital with an acute asthma attack. Patient demographics, asthma control level, asthma attack severity and the management of the attack were evaluated. There was no influence of gender on asthma control and attack severity. In 57.5% of the patients, asthma attack was moderate. Most patients (78.9%) were hospitalized with longer duration evident in the severe attack. Spirometry and chest X-Ray were the most frequent tests (85.4%), while steroids (72.0% parenteral; 29.0% oral) and short-acting beta-agonists (SABA) + anticholinergics (45.5%) were the main drugs of choice in the attack management. Attack severity and pre-attack asthma control level was significantly correlated (p attack asthma was uncontrolled in 42.6% of the patients with severe attack. Most of the patients were on combination of more than one (two in 38.7% and 3-4 in 31.2%) controller drugs before the attack. Providing country specific data on practice patterns in the management of acute asthma attack in a representative cohort in Turkey, prescription of steroids and SABA + anticholinergics as the main drugs of choice was in line with guidelines while the significant relation of pre-attack asthma control to risk/severity of asthma attack and rate/duration of hospitalization seem to be the leading results of the present study. Copyright © 2010 Elsevier Ltd. All rights reserved.
Background: Bronchial asthma is a global health problem that causes significant morbidity and mortality in all age groups. Global Initiative for Asthma (GINA) seeks to standardize the care asthma patients receive. We assessed the knowledge, attitude, and practices of doctors in Umuahia, Southeast Nigeria, regarding ...
Riemersma, Roland A.; Postma, Dirkje; van der Molen, Thys
Background: The management of asthma has changed since the introduction of budesonide/formoterol (Symbicort (R)) as both maintenance and reliever therapy (SMART). SMART and its effects on bronchial hyperresponsiveness (BHR) have not been studied in primary care. Aims: To compare the effects of SMART
Full Text Available Proper asthma management in schools is important in achieving optimum asthma control in children with asthma. The National Heart, Lung, and Blood Institute (NHLBI has developed guidelines on classroom asthma management. We conducted a systematic review to examine teacher knowledge of the NHLBI guidelines on asthma management in the classroom. We searched PubMed and EMBASE using search terms “asthma management,” “teacher(s,” “school teacher,” and “public school.” The inclusion criteria were articles published in English from 1994 to May 2014 that focus on schools in the United States (US. From 535 titles and abstracts, 9 studies met inclusion criteria. All studies reported that school teachers did not know the policies and procedures of asthma management. Teachers relied on school nurses to handle medical emergencies. Some studies identified that lack of full-time school nurses was a barrier to asthma management. Only one study showed directly that classroom teachers were not following the NHLBI guidelines on asthma management. Our literature review revealed that US teachers do not know the NHLBI guidelines on asthma management in the classroom. Future research should focus on interventions targeted toward training classroom teachers on asthma management as per NHLBI guidelines to ultimately improve asthma management in schools.
Duncan, Christina L; Walker, Heather A; Brabson, Laurel; Williford, Desireé N; Hynes, Lisa; Hogan, Mary Beth
Asthma action plans (AAPs) provide asthma management instructions to families; however, AAPs typically are written at a 7th-9th grade reading level, making them less useful in lower literacy families. There is a need to develop simpler AAP formats and content to optimize their utility across all families, including those who are rural and may be at a risk for literacy concerns. Because using pictures can simplify and enhance health education, our study's aim was to develop a pictorial AAP through a series of focus groups with key stakeholders - youth with asthma, caregivers, and physicians. Fourteen caregiver/youth dyads and four physicians participated in separate focus groups where their preferences for pictorial AAP structure and content were obtained. Focus groups were audio recorded, transcribed, coded with ATLAS.ti, and analyzed for themes. Youth and their caregivers prefer that the AAPs include simple, cartoon-like pictures customized to the patient. Physicians emphasized AAP's capability to display pictures of controller medication given its importance in preventing asthma exacerbations. A stoplight format, currently used in most written AAPs, received positive reviews. Specific suggestions for pictures showing symptoms, medications, and how to take medication were suggested. Words and short phrases accompanying the pictures were thought to add clarity. Key stakeholders viewed pictorial AAPs as positive and potentially effective alternatives to standard written AAPs. It is expected that low literacy youth and caregivers would more easily understand a pictorial AAP presentation, which should facilitate better medication adherence and asthma outcomes in these children.
Asthma exacerbations can do a lot of harm to the patients and consume large amounts of medical resources. This consensus is based on the domestic and foreign guidelines and literatures to standardize the evaluation and management of asthma exacerbations in China. Asthma exacerbations are characterized by a progressive increase in symptoms of shortness of breath, cough, wheezing or chest tightness and progressive decrease in lung function, and usually require modification of treatment. Recognizing risk factors and triggering factors of asthma exacerbations is helpful for the prevention and long-term management. Evaluation of asthma exacerbations is based on symptoms, lung function, and arterial blood gas. Management is stratified according to the severity of disease. Different regimens to treat asthma exacerbations are discussed in this consensus. Glucocorticoids should be used properly. Overuse of antibiotics should be avoided. Management of life-threatening asthma is discussed separately. Special attention should be paid in some special respects, such as asthma during peri-operation period, gestation period, and childhood. Diagnosis and management of complications are also of great significance and are discussed in details.
Searle, Aidan; Jago, Russell; Henderson, John; Turner, Katrina M
The management of childhood asthma is often sub-optimal. Parents and other caregivers are primarily responsible for disease management and this responsibility includes communication with health professionals. The aim of this multi-perspective qualitative study was to explore the views of children, parents and health professionals to gain insight into the approach to clinical care in the management of childhood asthma. Interviews were held with nine parent-child (6-8 years) dyads, and 13 health professionals working in primary and secondary care. Interviews were transcribed verbatim and analysed thematically. Three key themes emerged that were common to all data sets; (1) Child and parent awareness of symptoms; (2) Management and child wellbeing; and (3) Professional communication education and consultation with families. Although some children demonstrate good awareness of symptoms and appropriate use of medication, some parents expressed difficulty in identifying triggers and symptoms of asthma. Furthermore, parents lacked awareness regarding appropriate use of medication for preventing and managing symptoms of asthma. Health professionals believed that communication and education was lacking. Data from all participants suggested that consultations could be enhanced with greater emphasis on children's and parents' perceptions of asthma in the development of asthma management plans. GUIDING FAMILIES THROUGH DISEASE MANAGEMENT: Both parents' and children's perceptions and understanding of childhood asthma should be considered when developing asthma management plans. The management of asthma is challenging and can result in poor disease outcomes if care is not taken. An individual's perception of their (or their child's) asthma can also affect the efficacy of treatment. Aidan Searle at the Bristol Biomedical Research Centre, UK, and co-workers, interviewed nine parent-child groups and thirteen health professionals to determine their perceptions of childhood asthma
Hurd, Suzanne S; Lemanske, Robert F; Becker, Allan
in this age group. For this reason, to aid in the diagnosis of asthma in young children, a symptoms-only descriptive approach that includes the definition of various wheezing phenotypes has been recommended. In 1993, the Global Initiative for Asthma (GINA) was implemented to develop a network of individuals...... and our ability to manage and control it effectively. However, in children 5 years and younger, the clinical symptoms of asthma are variable and non-specific. Furthermore, neither airflow limitation nor airway inflammation, the main pathologic hallmarks of the condition, can be assessed routinely......, organizations, and public health officials to disseminate information about the care of patients with asthma while at the same time assuring a mechanism to incorporate the results of scientific investigations into asthma care. Since then, GINA has developed and regularly revised a Global Strategy for Asthma...
Speck, Aimee L; Hess, Michael; Baptist, Alan P
Health disparities are seen in many chronic conditions including asthma. Young African American adults represent a population at high risk for poor asthma outcomes due to both their minority status and the difficult transition from adolescence to adulthood. Recruitment and retention has been challenging in this demographic stratum, and traditional asthma education is often not feasible. The objective of this study was to develop and assess the feasibility of an electronic asthma self-management program for young African American adults. A total of 44 African American adults (age 18-30 years) with uncontrolled persistent asthma were enrolled in an asthma self-management program. The 6-week Breathe Michigan program (predicated on the social cognitive theory) was tailored specifically to the concerns and preferences of young African American adults. The entire program was completed electronically, without any specialized human support. At 2 weeks and 3 months after program completion, participants were contacted for follow-up. A total of 89% of enrolled subjects completed the 6-week intervention, and 77% were available for evaluation at 3 months. All subjects completing the 2-week postprogram survey reported that the program was helpful, and 97% would recommend it to others. Asthma control as measured by the Asthma Control Test improved from 16.1 to 19.3 (P young African American adults. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Hosseini, Anahita; Buonocore, Chris M; Hashemzadeh, Sepideh; Hojaiji, Hannaneh; Kalantarian, Haik; Sideris, Costas; Bui, Alex A T; King, Christine E; Sarrafzadeh, Majid
Asthma is the most prevalent chronic disease among pediatrics, as it is the leading cause of student absenteeism and hospitalization for those under the age of 15. To address the significant need to manage this disease in children, the authors present a mobile health (mHealth) system that determines the risk of an asthma attack through physiological and environmental wireless sensors and representational state transfer application program interfaces (RESTful APIs). The data is sent from wireless sensors to a smartwatch application (app) via a Health Insurance Portability and Accountability Act (HIPAA) compliant cryptography framework, which then sends data to a cloud for real-time analytics. The asthma risk is then sent to the smartwatch and provided to the user via simple graphics for easy interpretation by children. After testing the safety and feasibility of the system in an adult with moderate asthma prior to testing in children, it was found that the analytics model is able to determine the overall asthma risk (high, medium, or low risk) with an accuracy of 80.10 ± 14.13%. Furthermore, the features most important for assessing the risk of an asthma attack were multifaceted, highlighting the importance of continuously monitoring different wireless sensors and RESTful APIs. Future testing this asthma attack risk prediction system in pediatric asthma individuals may lead to an effective self-management asthma program.
Yawn, Barbara P; Han, MeiLan K
Although often considered a disease of childhood, the prevalence of asthma in US adults aged 65 years or older is similar to that in children, with the number of older patients needing care for asthma likely to continue to increase. As with most chronic diseases, there are challenges associated with the diagnosis and management of asthma in an older population. This review discusses these challenges, suggesting practical management strategies for primary care physicians and their teams. Asthma comprises a spectrum of phenotypes, some associated with adult onset. The symptoms and characteristics of patients with late-onset asthma can differ from those of patients with early-onset disease. Furthermore, older patients may fail to recognize respiratory symptoms as abnormal and have other comorbidities, complicating the differential diagnosis of asthma. Once diagnosed, the long-term goals of asthma management are no different in older adults than in anyone with asthma, with inhaled corticosteroids being the cornerstone of therapy. Comorbid conditions become more common with age and have a direct impact on a patient's respiratory symptoms and potential adverse effects of therapy, thereby influencing the choice of therapies and delivery systems and potentially increasing the likelihood of complex polypharmacy. In conclusion, asthma, although traditionally considered a disease of the young, should be considered as a potential diagnosis in older adults with respiratory symptoms, even without a history of asthma or allergies. As with all patients, the primary goals of asthma management in older adults are symptom control and exacerbation reduction. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
Kuethe, Maarten C.; Vaessen-Verberne, Anja A. P. H.; Elbers, Roy G.; van Aalderen, Wim M. C.
Background Asthma is the most common chronic disease in childhood and prevalence is also high in adulthood, thereby placing a considerable burden on healthcare resources. Therefore, effective asthma management is important to reduce morbidity and to optimise utilisation of healthcare facilities.
Panzera, Anthony D.; Schneider, Tali K.; Martinasek, Mary P.; Lindenberger, James H.; Couluris, Marisa; Bryant, Carol A.; McDermott, Robert J.
Background: Self-management of asthma can now leverage new media technologies. To optimize implementation they must employ a consumer-oriented developmental approach. This study explored benefits of and barriers to improved asthma self-management and identified key elements for the development of a digital media tool to enhance asthma control.…
Occupational exposure to irritants accounts for 2% to 15% of all cases of asthma. Most of the offending agents evoke an IgE allergic reaction, but some seem to act through pharmacologic rather than immunologic pathways. Usually, symptoms are worse during working hours and improve in the evening and over the weekend, but in some cases onset is delayed. Symptoms may persist for weeks after exposure ceases. Skin tests or serologic tests for IgE antibody are helpful in diagnosis. Bronchial challenge with the suspected agent is valuable research procedure that occasionally is clinically useful in diagnosis. Management requires the cooperation of the medical and industrial communities. It consists of identifying asthmatic workers, removing them from exposure to the affecting environment, and treating their symptoms; preventing exposure of susceptible people through preemployment screening; and setting and adhering to reasonable occupational safety standards
Full Text Available In the article, the authors justify the necessity to apply non medicamentous treatment methods to the children with bronchial asthma. The scientists familiarize us with a new me dication, whose effect is based on the noninvasive impact of the electromagnetic radiation of the knowingly non thermal intensity. It is for normalization of the disturbed function of the respiratory system. The researchers showed the efficiency of the above said innovative medication, while treating bronchial asthma among children with no side effects whatsoever.Key words: bronchial asthma, nonmedicamentous treatment methods, children.
Responses to the questionnaire on the diagnosis, patient education and management of asthma indicated that a reduced number of patients with severe asthma were seen in 1993 in both Pediatric and Internal Medicine Departments compared with 5 years before, despite the increase in total number of asthma patients in Japan. Specifiic IgE radioallergosorbent test (RAST measurements were frequently performed instead of skin testing for diagnosis, and eosinophil count and bronchodilator response served as an adjunct to the diagnosis. Patients were frequently asked detailed questions about aspirin-induced asthma, which accounted for 8.8, 2.2 and 1.5% of patients with asthma in the adult, schoolchildren (6–16 years and infant (≤ 5 years groups, respectively. In achieving ‘control of asthma’, first priority was given to coping with the symptoms in children aged 5 years or less and to enabling routine daily life activities in patients 6 years of age or older. Usefulness of peak flow measurements was widely recognized and a detailed plan for allergen avoidance (house dust was often given to patients.
Thompson, M.; Calkin, D. E.; Hand, M. S.; Kreitler, J.
In this presentation we address federal wildfire risk management largely through the lens of economics, targeting questions related to costs, effectiveness, efficiency, and tradeoffs. Beyond risks to resources and assets such as wildlife habitat, watersheds, and homes, wildfires present financial risk and budgetary instability for federal wildfire management agencies due to highly variable annual suppression costs. Despite its variability, the costs of wildfire management have continued to escalate and account for an ever-growing share of overall agency budgets, compromising abilities to attain other objectives related to forest health, recreation, timber management, etc. Trends associated with a changing climate and human expansion into fire-prone areas could lead to additional suppression costs in the future, only further highlighting the need for an ability to evaluate economic tradeoffs in investments across the wildfire management spectrum. Critically, these economic analyses need to accurately capture the complex spatial and stochastic aspects of wildfire, the inherent uncertainty associated with monetizing environmental impacts of wildfire, the costs and effectiveness of alternative management policies, and linkages between pre-fire investments and active incident management. Investing in hazardous fuels reduction and forest restoration in particular is a major policy lever for pre-fire risk mitigation, and will be a primary focus of our presentation. Evaluating alternative fuel management and suppression policies could provide opportunities for significant efficiency improvements in the development of risk-informed management fire management strategies. Better understanding tradeoffs of fire impacts and costs can help inform policy questions such as how much of the landscape to treat and how to balance investments in treating new areas versus maintaining previous investments. We will summarize current data needs, knowledge gaps, and other factors
Garbutt, Jane M; Yan, Yan; Strunk, Robert C
Although specialist asthma care improves children's asthma outcomes, the impact of primary care management is unknown. To determine whether variation in preventive and acute care for asthma in pediatric practices affects patients' outcomes. For 22 practices, we aggregated 12-month patient data obtained by chart review and parent telephone interviews for 948 children, 3 to 12 years old, diagnosed with asthma to obtain practice-level measures of preventive (≥1 asthma maintenance visit/year) and acute (≥1 acute asthma visit/year) asthma care. Relationships between practice-level measures and individual asthma outcomes (symptom-free days, parental quality of life, emergency department [ED] visits, and hospitalizations) were explored using generalized estimating equations, adjusting for seasonality, specialist care, Medicaid insurance, single-family status, and race. For every 10% increase in the proportion of children in the practice receiving preventive care, symptom-free days per child increased by 7.6 days (P = .02) and ED visits per child decreased by 16.5% (P = .002), with no difference in parental quality of life or hospitalizations. Only the association between more preventive care and fewer ED visits persisted in adjusted analysis (12.2% reduction; P = .03). For every 10% increase in acute care provision, ED visits per child and hospitalizations per child decreased by 18.1% (P = .02) and 16.5% (P asthma care had improved outcomes, both impairment and risk. Persistence of improved risk outcomes in the adjusted analyses suggests that practice-level interventions to increase asthma care may reduce childhood asthma disparities. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Lalloo, U G; McIvor, R A
Asthma is a chronic inflammatory disease of the lungs associated with significant morbidity and mortality worldwide. Adoption of current treatment guidelines that propose inhaled corticosteroids (ICS) as the foundation for asthma treatment should control most patients with chronic asthma. Rapid-acting inhaled beta (beta) 2-agonists are best reserved for acute symptom relief. Long-acting beta-2-agonists in combination with ICS are the most effective asthma treatment currently available when asthma is not controlled on low-dose ICS alone; however, they are not universally available due to cost. Slow-release theophylline may be an alternative cost-effective add-on therapy to ICS in resource-poor areas, although its potential for toxicity has limited its use over the last decade. New targeted anti-inflammatory therapies lack the broad anti-inflammatory activity of ICS and are unaffordable in most settings. Implementation of guidelines for asthma care is an unresolved challenge, and major gaps in asthma care are consistent across the globe. Review of asthma management worldwide shows that control of the disease in relation to the Global Initiative for Asthma (GINA) goals of asthma treatment is not achieved in a large proportion of patients, despite the widespread availability of guidelines and even with access to effective treatment in resource-rich settings. Many resource-poor countries have the additional challenge of lack of access to basic asthma treatment such as ICS. The challenge is to provide global access to core asthma medications, particularly ICS, at affordable prices, to improve implementation of treatment guidelines and to encourage better health care provider and patient education.
Regli, Adrian; von Ungern-Sternberg, Britta S
As asthma is a frequent disease especially in children, anesthetists are increasingly providing anesthesia for children requiring elective surgery with well controlled asthma but also for those requiring urgent surgery with poorly controlled or undiagnosed asthma. This second part of this two-part review details the medical and ventilatory management throughout the perioperative period in general but also includes the perioperative management of acute bronchospasm and asthma exacerbations in children with asthma. Multiple observational trials assessing perioperative respiratory adverse events in healthy and asthmatic children provide the basis for identifying risk reduction strategies. Mainly, animal experiments and to a small extent clinical data have advanced our understanding of how anesthetic agents effect bronchial smooth muscle tone and blunt reflex bronchoconstriction. Asthma treatment outside anesthesia is well founded on a large body of evidence.Perioperative prevention strategies have increasingly been studied. However, evidence on the perioperative management, including mechanical ventilation strategies of asthmatic children, is still only fair, and further research is required. To minimize the considerable risk of perioperative respiratory adverse events in asthmatic children, perioperative management should be based on two main pillars: the preoperative optimization of asthma treatment (please refer to the first part of this two-part review) and - the focus of this second part of this review - the optimization of anesthesia management in order to optimize lung function and minimize bronchial hyperreactivity in the perioperative period.
Nasser Fegh-hi FARAHMAND
Full Text Available Organizational Actively Management (OAM is the responsibility of every manager. Because, an approach for OAM is becoming more widely accepted is a community-based development approach. In Opportunity Hunting Approach (OHA, OAM is the responsibility of every manager for his/her actions. OAM is using from top to bottom development model. According to the survey of market and customers, after understand customers’ needs, organization then decide how the quality policy and target will develop, from there the actively management system can be developed. The aim of this study in field of organizational actively management and policy of it can provide the specific process required for setting up and monitoring the actively target. As it also is customer-oriented, it aims to improve customer satisfaction. In addition, the actively target should be set up and implemented within every organization department and at each level, in accordance with actively policy. Furthermore, organization should develop the actively management system, in order to conform to general requirements and actively target.
Krutzch, Christine B.; And Others
A technology transfer project for getting initial community adoption of childhood asthma management programs is described. The evolution of the project, including development of programs, packaging considerations, establishment of partnerships, implementation, and evaluation are discussed. (Author/CH)
Mammen, Jennifer; Rhee, Hyekyun; Norton, Sally A; Butz, Arlene M; Halterman, Jill S; Arcoleo, Kimberly
A previous definition of adolescent asthma self-management was derived from interviews with clinicians/researchers and published literature; however, it did not incorporate perspectives of teens or parents. Therefore, we conducted in-depth interviews with teens and parents and synthesized present findings with the prior analysis to develop a more encompassing definition and model. Focal concepts were qualitatively extracted from 14-day self-management voice-diaries (n = 14) and 1-hour interviews (n = 42) with teens and parents (28 individuals) along with concepts found in the previous clinical/research oriented analysis. Conceptual structure and relationships were identified and key findings synthesized to develop a revised definition and model of adolescent asthma self-management. There were two primary self-management constructs: processes of self-management and tasks of self-management. Self-management was defined as the iterative process of assessing, deciding, and responding to specific situations in order to achieve personally important outcomes. Clinically relevant asthma self-management tasks included monitoring asthma, managing active issues through pharmacologic and non-pharmacologic strategies, preventing future issues, and communicating with others as needed. Self-management processes were reciprocally influenced by intrapersonal factors (both cognitive and physical), interpersonal factors (family, social and physical environments), and personally relevant asthma and non-asthma outcomes. This is the first definition of asthma self-management incorporating teen, parent, clinician, and researcher perspectives, which suggests that self-management processes and behaviors are influenced by individually variable personal and interpersonal factors, and are driven by personally important outcomes. Clinicians and researchers should investigate teens' symptom perceptions, medication beliefs, current approaches to symptom management, relevant outcomes, and
This review assesses the evidence regarding the use of long-acting beta(2)-agonists in the management of pediatric asthma. Thirty double-blind, randomized, controlled trials on the effects of formoterol and salmeterol on lung function in asthmatic children were identified. Single doses of inhaled......, long-acting beta(2)-agonists provide effective bronchodilatation and bronchoprotection when used as intermittent, single-dose treatment of asthma in children, but not when used as regular treatment. Future studies should examine the positioning of long-acting beta(2)-agonists as an "as needed" rescue...... medication instead of short-acting beta(2)-agonists for pediatric asthma management....
Elaro, Amanda; Shah, Smita; Armour, Carol L; Bosnic-Anticevich, Sinthia
The aim of this study is to identify the current status of pediatric asthma management in the Australian community pharmacy setting from the pharmacists' perspective. This research will allow us to identify training needs of community pharmacists. Pharmacists were recruited from the Sydney metropolitan region and asked to complete a self-reported questionnaire that elucidated information on four general domains relating to pediatric asthma management within community pharmacy. All data collected were analysed descriptively. Bivariate Pearson correlations were performed to determine whether interrelationships existed between specific domains. All 77 pharmacists completed the questionnaire. Thirty-two percent had not completed any asthma related CPD in the past year and only 25% of pharmacists reported using the national asthma guidelines in practice. Just over half of the pharmacists (54%) reported that they provide device technique demonstrations for new inhaled medicines, and 35% of pharmacists reported that they check for written asthma self-management plan possession. Although 65% of pharmacists reported confidence in communication skills, most pharmacists were not confident in setting short-/long-term goals with the patient and carer for managing asthma at home. Pharmacists believed that they are just as effective as doctors in providing asthma counseling and education. Lack of time was identified as a significant barrier. We have identified a gap between guideline recommended practices and the self-reported practices of community pharmacists. Pharmacists need more appropriate continuing education programs that can translate into improved pediatric asthma self-management practices and thus improved asthma outcomes in children. This may require an alternative approach.
Azuma, Naoto; Katada, Yoshinori; Kobayashi, Masaaki; Kojima, Makiko; Nakajima, Yumi; Shibano, Miyo; Tomita, Hitomi; Yamanaka, Takao; Harada, Yoshinori; Ishii, Taeko; Saeki, Yukihiko
There have been few reports of clinical pathway (CP) for treatment of asthma attack, because patients with asthma always admit emergently and the severity varies. We introduced CP so that standard asthma treatment can be widely used, and investigated its clinical usefulness. We designed a new CP for treating asthma attack according to the guideline (Japanese guideline (JGL) and Global Initiative for Asthma (GINA)). 136 patients who admitted to our hospital due to asthma attack from January 1999 to November 2006, were enrolled our study. Excluding cases complicated with pneumonia, COPD or cardiac failure, we evaluated 46 cases treated with the CP comparing with 19 cases treated without the CP. The clinical evaluations include systemic and inhaled steroid use, FEV1.0%, history of asthma, and the duration of asthma attack. Furthermore, we investigated difference between cases with and without prolonged admission. While the rates of systemic and inhaled steroid use in cases without the CP were 57.9% and 52.6% respectively, those in cases with the CP were approximately 100%. Employing the CP, FEV 1.0% at discharge time was elevated from 71.7% to 76.3% and the duration of hospitalization was shortened from 14.2 days to 11.5 days. Mean age of the cases with prolonged admission was higher than the rest. The asthma CP is an effective way for the standard treatment according to the guideline to be used widely even by doctors who are not familiar with asthma treatment. It improves the efficacy of in-hospital treatment.
Full Text Available Abstract Background Apps have been enthusiastically adopted by the general public. They are increasingly recognized by policy-makers as a potential medium for supporting self-management of long-term conditions. We assessed the degree to which current smartphone and tablet apps for people with asthma offer content and tools of appropriate quality to support asthma self-management. Methods We adapted systematic review methodology to the assessment of apps. We identified English-language asthma apps for all ages through a systematic search of official app stores. We systematically assessed app content using criteria derived from international guidelines and systematic review of strategies for asthma self-management. We covered three domains: comprehensiveness of asthma information, consistency of advice with evidence and compliance with health information best practice principles. Results We identified 103 apps for asthma in English, of which 56 were sources of information about the condition and 47 provided tools for the management of asthma. No apps offered both types of functionality. Only three information apps approached our definition of comprehensiveness of information about asthma. No apps provided advice on lay management of acute asthma that included details of appropriate reliever medication use. In 32 of 72 instances, apps made unequivocal recommendations about strategies for asthma control or prophylaxis that were unsupported by current evidence. Although 90% of apps stated a clear purpose, compliance with other best practice principles for health information was variable. Contact details were located for 55%, funding source for 18% and confidentiality policy for 17%. Conclusions No apps for people with asthma combined reliable, comprehensive information about the condition with supportive tools for self-management. Healthcare professionals considering recommending apps to patients as part of asthma self-management should exercise
Saini, Bandana; Filipovska, Julija; Bosnic-Anticevich, Sinthia; Taylor, Susan; Krass, Ines; Armour, Carol
To compare the effect of a pharmacist-delivered rural asthma management service (RAMS) on health outcomes for people with asthma in a rural/regional area with 'standard care' delivered through community pharmacies. A parallel group controlled repeated measures study. Community pharmacies in Central West New South Wales. Standardised protocols and resources based on national asthma management guidelines, delivered by specially trained community pharmacists. Patients visited the pharmacy at baseline and 1, 3 and 6 months after baseline in the intervention group and at baseline plus 6 months after baseline in the control group. The intervention pharmacists (n = 12) were trained to deliver the RAMS model, while control pharmacists (n = 8) provided standard asthma care to their recruited patients. Fifty-one and 39 patients were recruited by intervention and control pharmacists. Asthma severity score which was a composite score based on recency, frequency and severity of asthma symptoms, and asthma history. Data compared at the final visit between groups indicated that the RAMS patient group demonstrated a significant reduction in the asthma severity scores (7.9 +/- 2.6 versus 10.4 +/- 2.6, P < 0.001); a reduction in the risk of non-adherence to medication scores (1.6 +/- 0.7 versus 2.3 +/- 1.1, P < 0.001); and an increase in the proportion of patients owning a written action plan (50% versus 23%, P = 0.04). These results indicated that the community pharmacy-based RAMS model can improve asthma outcomes for patients in rural settings, and similar models for asthma and other chronic diseases should be tested rigorously and adopted in rural primary care practice.
Londoño, Ana Maria Moreno; Schulz, Peter J
The majority of current health literacy tools assess functional skills including reading, writing, and numeracy. Although these tools have been able to underline the impact of such skills on individuals' health behaviour, there is a need for comprehensive measures to examine more advanced skills. The individual's ability to use health-related information considering his/her own health context, and judging positive and negative consequences of their decisions has been conceptualized as judgment skills. The present study used a newly developed judgment skills tool to explore asthma self-management practices. Eighty asthma patients were recruited from medical offices during the year 2013. The questionnaire was self-administered and contained health literacy questions, the judgment skill tool, the Asthma Control Test, and several self-management questions. Sixty-nine percent of participants had adequate health literacy, while 24% and 5% had marginal and inadequate levels, respectively. The high-judgment group referred more to their doctor when experiencing asthma problems t(76)=-2.18, Pskills tool can help identify asthma patients' health information use and reveal how this use may affect some self-management practices. Significance for public healthPatients' health literacy has a great impact on their health behaviours and their health outcomes. Therefore, it has become more and more common to measure health literacy within the healthcare setting to determine the most effective approach to target patients. The measurement of asthma judgment skills contribute to a deeper understanding of patients' asthma self-management in crucial topics for asthma control, and have the advantage of assessing the specific abilities needed for this particular condition, which in turn benefits the translation of the findings from the use of this tool into strategies that directly tackle the needs of asthma patients.
Levy, Mark L; Ward, Angela; Nelson, Sara
An asthma attack or exacerbation signals treatment failure. Most attacks are preventable and failure to recognize risk of asthma attacks are well recognized as risk factors for future attacks and even death. Of the 19 recommendations made by the United Kingdom National Review of Asthma Deaths (NRAD) (1) only one has been partially implemented-a National Asthma Audit; however, this hasn't reported yet. The Harrow Clinical Commissioning Group (CCG) in London implemented a clinical asthma audit on 291 children and young people aged under 19 years (CYP) who had been treated for asthma attacks in 2016. This was funded as a Local Incentive Scheme (LIS) aimed at improving quality health care delivery. Two years after the publication of the NRAD report it is surprising that risks for future attacks were not recognized, that few patients were assessed objectively during attacks and only 10% of attacks were followed up within 2 days. However, it is encouraging that CYP hospital admissions following the audit were reduced by 16%, with clear benefit for patients, their families and the local health economy. This audit has provided an example of how clinicians can focus learning on patients who have had asthma attacks and utilize these events as a catalyst for active reflection in particular on modifiable risk factors. Through identification of these risks and active optimization of management, preventable asthma attacks could become 'never events'.
Ingram, Samuel T.
Digital tools have impacted traditional methods employed to reproduce color images during the past decade. The shift from a purely photomechanical process in color reproduction to colorimetric reproduction offers tremendous opportunity in the graphic arts industry. But good things do not necessarily come to all in the same package. Printing processes possess different reproduction attributes: tone reproduction, gray balance and color correction requirements are as different as the ingredient sets selected for color reproduction. This paper will provide insight toward understanding advantages and limitations offered by the new digital technologies in printing, publishing and packaging. For the past five years the Clemson University Graphic Communications Department has conducted numerous color projects using the new digital colorimetric tools during the previous decade. Several approaches have been used including experimental research and typical production workflows. The use of colorimetric data in color reproduction has given an opportunity to realize real gains in color use, predictability and consistency. Meeting an image's separation and reproduction requirements for a specified printing process can involve disruption of the anticipated workflow. Understanding the printing process requirements and the fit within the specifications of a colorimetric workflow are critical to the successful adoption of a color managed workflow. The paper will also provide an insight into the issues and challenges experienced with a color managed workflow. The printing processes used include offset litho, narrow and wide-web flexography (paper, liner board, corrugated and film), screen printing (paper board and polycarbonates), and digital imaging with toner, ink and inkjet systems. A proposal for technology integration will be the focus of the presentation drawn from documented experiences in over 300 applications of color management tools. Discussion will include the structure of
Ricardo A Tan
Full Text Available Ricardo A Tan1, Jonathan Corren21California Allergy and Asthma Medical Group, Los Angeles, CA; 2Allergy Research Foundation, Los Angeles, CA, USAAbstract: Inhaled corticosteroids (ICS have proven to be the most effective and essential therapy for the treatment of bronchial asthma. The 2007 National Asthma Education and Prevention Program guidelines recommend ICS as preferred therapy for patients with mild to severe persistent asthma. Mometasone furoate (MF is a relatively new ICS agent with high affinity for the glucocorticoid receptor. It is approved in the US for maintenance treatment of asthma for patients 4 years of age and older. It has been shown to be well tolerated with no significant adverse side effects observed in clinical trials and post-marketing surveillance. The efficacy of mometasone furoate has been established in large, well-designed studies. In patients with persistent asthma previously treated either with short-acting beta-agonists alone or twice-daily maintenance therapy with ICS, once-daily MF has been shown to be superior to placebo in improving lung function, symptom control, and quality of life; and has shown comparable efficacy compared with budesonide, beclomethasone, and fluticasone. Twice-daily dosing with MF has been demonstrated to successfully allow for reduction or elimination of oral corticosteroids in severe asthmatics.Keywords: inhaled steroids, mometasone furoate, once-daily dosing, asthma, stepwise approach
Full Text Available Clarisse Gautier,1 Denis Charpin1,2 1Department of Pulmonology and Allergy, North Hospital, 2Faculty of Medicine, Aix-Marseille University, Marseille, France Abstract: Identifying asthma triggers forms the basis of environmental secondary prevention. These triggers may be allergenic or nonallergenic. Allergenic triggers include indoor allergens, such as house dust mites (HDMs, molds, pets, cockroaches, and rodents, and outdoor allergens, such as pollens and molds. Clinical observations provide support for the role of HDM exposure as a trigger, although avoidance studies provide conflicting results. Molds and their metabolic products are now considered to be triggers of asthma attacks. Pets, dogs, and especially cats can undoubtedly trigger asthmatic symptoms in sensitized subjects. Avoidance is difficult and rarely adhered to by families. Cockroach allergens contribute to asthma morbidity, and avoidance strategies can lead to clinical benefit. Mouse allergens are mostly found in inner-city dwellings, but their implication in asthma morbidity is debated. In the outdoors, pollens can induce seasonal asthma in sensitized individuals. Avoidance relies on preventing pollens from getting into the house and on minimizing seasonal outdoor exposure. Outdoor molds may lead to severe asthma exacerbations. Nonallergenic triggers include viral infections, active and passive smoking, meteorological changes, occupational exposures, and other triggers that are less commonly involved. Viral infection is the main asthma trigger in children. Active smoking is associated with higher asthma morbidity, and smoking cessation interventions should be personalized. Passive smoking is also a risk factor for asthma exacerbation. The implementation of public smoking bans has led to a reduction in the hospitalization of asthmatic children. Air pollution levels have been linked with asthmatic symptoms, a decrease in lung function, and increased emergency room visits and
Kosse, Richelle C; Bouvy, Marcel L; de Vries, Tjalling W; Kaptein, Ad A; Geers, Harm Cj; van Dijk, Liset; Koster, Ellen S
Poor medication adherence in adolescents with asthma results in poorly controlled disease and increased morbidity. The aim of the ADolescent Adherence Patient Tool (ADAPT) study is to develop an mHealth intervention to support self-management and to evaluate the effectiveness in improving medication adherence and asthma control. The ADAPT intervention consists of an interactive smartphone application (app) connected to a desktop application for health care providers, in this study, the community pharmacist. The app contains several functions to improve adherence as follows: 1) a questionnaire function to rate asthma symptoms and monitor these over time; 2) short movie clips with medication and disease information; 3) a medication reminder; 4) a chat function with peers; and 5) a chat function with the pharmacist. The pharmacist receives data from the patient's app through the desktop application, which enables the pharmacist to send information and feedback to the patient. The ADAPT intervention is tested in a community pharmacy-based cluster randomized controlled trial in the Netherlands, aiming to include 352 adolescents with asthma. The main outcome is adherence, measured by patient's self-report and refill adherence calculated from pharmacy dispensing records. In addition, asthma control, illness perceptions, medication beliefs, and asthma-related quality of life are measured. This study will provide in-depth knowledge on the effectiveness of an mHealth intervention to support asthma self-management in adolescents. These insights will also be useful for adolescents with other chronic diseases.
Melo, Janaina; Moreno, Adriana; Ferriani, Virginia; Araujo, Ana Carla; Vianna, Elcio; Borges, Marcos; Roxo, Pérsio; Gonçalves, Marcos; Mello, Luane; Parreira, Rosa; Silva, Jorgete; Stefanelli, Patricia; Panazolo, Larissa; Cetlin, Andrea; Queiroz, Luana; Araujo, Rosângela; Dias, Marina; Aragon, Davi; Domingos, Nélio; Arruda, L Karla
Asthma is under-diagnosed in many parts of the world. We aimed to assess the outcome of a capacitating program on asthma for non-specialist physicians and other healthcare professionals working in the public system in Ribeirão Preto, Brazil. A group of 16 asthma specialists developed a one-year capacitating program in 11 healthcare clinics in the Northern District of the city, which included lectures on asthma, training on inhalation device use and spirometry, and development of an asthma management protocol. Researchers visited one health unit 2-4 times monthly, working with doctors on patients' care, discussing cases, and delivering lectures. Asthma education was also directed to the general population, focusing on recognition of signs and symptoms and long-term treatment, including production of educational videos available on YouTube. Outcome measures were the records of doctors' prescriptions of individual asthma medications pre- and post-intervention. Prior to the program, 3205 units of inhaled albuterol and 2876 units of inhaled beclomethasone were delivered by the Northern District pharmacy. After the one-year program, there was increase to 4850 units (51.3%) for inhaled albuterol and 3526 units (22.6%) for inhaled beclomethasone. The albuterol increase followed the recommendation given to the non-specialist doctors by the asthma experts, that every patient with asthma should have inhaled albuterol as a rescue medication, by protocol. No increase was observed in other districts where no capacitating program was conducted. A systematic capacitating program was successful in changing asthma prescription profiles among non-specialist doctors, with increased delivery of inhaled albuterol and beclomethasone.
EPA provides the general public, partners, media outlets and health care professionals with a wide variety of asthma resources at no-cost. EPA develops resources to share information about asthma, its triggers, and comprehensive asthma management.
Public Health Agency
This action plans allow each child (or parent/carer) to record his or her asthma treatment to help manage their asthma when they are well, when their symptoms get worse and when they are suffering an asthma attack.
Wakayama, Hisashi; Ogasawara, Tomohiko; Sato, Ai; Honda, Mamiko; Sakurai, Keiko; Uemura, Takehiro; Kasai, Daishi; Kato, Hisaaki; Tomita, Yuka; Park, Jangchul; Mizuno, Akiko; Suzuki, Masayuki
Although most patients of asthma can be controlled by inhaled corticosteroid (ICS), some patients remain uncontrolled even after the introduction of ICS treatment. In management of such difficult-to-treat asthma, systematic review including additional differential diagnosis and avoidance of exacerbating factors is very important. Here we postulate a flow sheet presenting an algorithm which intends to achieve better asthma control following ATS refractory asthma guidance. For patients with poor controlled asthma even after using ICS more than moderate dose, we used the sheet in our daily outpatient management and investigated whether we could improve the control in such patients. The sheet was constructed by an algorithm which included (1) reevaluation of inhalation technique of ICS; (2) additional differential diagnosis of COPD and other similar diseases; and (3) reevaluation of presence of exacerbating factors. In our outpatient department, seven clinicians managed 22 difficult-to-treat asthma patients using this sheet. Additional factors which might worsen asthma control could be detected in 21 patients (95.5%). Firstly, smoking was disclosed in 8 patients (36.4%). Secondly, keeping pets was identified in 7 patients (31.8%). 5 patients (22.7%) were diagnosed as COPD rather than asthma and 4 patients (18.2%) were diagnosed as having rhinosinusitis. Some improvement of asthma control was achieved in 9 patients (40.9%). Reevaluation of refractory asthma patients using our newly developed flow sheet is essential and it may facilitate understanding of management of difficult-to-treat asthma.
Hosseini, Anahita; Buonocore, Chris M.; Hashemzadeh, Sepideh; Hojaiji, Hannaneh; Kalantarian, Haik; Sideris, Costas; Bui, Alex A.T.; King, Christine E.; Sarrafzadeh, Majid
Asthma is the most prevalent chronic disease among pediatrics, as it is the leading cause of student absenteeism and hospitalization for those under the age of 15. To address the significant need to manage this disease in children, the authors present a mobile health (mHealth) system that determines the risk of an asthma attack through physiological and environmental wireless sensors and representational state transfer application program interfaces (RESTful APIs). The data is sent from wirel...
Espinoza-Palma, Tatiana; Zamorano, Alejandra; Arancibia, Francisca; Bustos, María-Francisca; Silva, Maria José; Cardenas, Consuelo; De La Barra, Pedro; Puente, Victoria; Cerda, Jaime; Castro-Rodriguez, José A; Prado, Francisco
Background. Formal education in primary care can reduce asthma exacerbations. However, there are few studies in hospitalized children, with none originating in Latin America. Methods. A prospective randomized study was designed to evaluate whether a full education with self-management plan (ESM) was more effective than an education without self-management plan (E) in reducing asthma hospitalization. Children (5 to 15 years of age) who were hospitalized for an asthma attack were divided in two groups. Children in the E group received general instructions based on a booklet. Those in the ESM group received the same booklet plus a self-management guide and a puzzle game that reinforces the lessons learned in the booklet. Patients were interviewed every 3 months, by telephone, for one year. Interviewers recording the number of hospitalizations, exacerbations, and emergency visits for asthma and oral steroid burst uses. Results. From 88 children who met the inclusion criteria, 77 (86%) completed one year of follow-up (41 from E and 36 from ESM group). Overall, after one year, the hospitalization decreased by 66% and the inhaled corticosteroids therapy increased from 36% to 79%. At the end of the study, there was no difference in exacerbations, emergency visits, oral steroid burst uses, or hospitalizations between the two groups. Conclusions. Asthma education with or without a self-management plan during asthma hospitalization were effective in reducing exacerbations, emergency visits, oral steroid burst uses, and future rehospitalizations. This evidence supports the importance of providing a complete asthma education plan in any patient who is admitted for asthma exacerbation.
Hanna, Tamer; Bajorek, Beata; Lemay, Kate; Armour, Carol L.
Braido, Fulvio; Baiardini, Ilaria; Alleri, Pietro; Bacci, Elena; Barbetta, Carlo; Bellocchia, Michela; Benfante, Alida; Blasi, Francesco; Bucca, Caterina; Busceti, Maria Teresa; Centanni, Stefano; Colanardi, Maria Cristina; Contoli, Marco; Corsico, Angelo; D'Amato, Maria; Di Marco, Fabiano; Marco, Dottorini; Ferrari, Marta; Florio, Giovanni; Fois, Alessandro Giuseppe; Foschino Barbaro, Maria Pia; Silvia, Garuti; Girbino, Giuseppe; Grosso, Amelia; Latorre, Manuela; Maniscalco, Sara; Mazza, Francesco; Mereu, Carlo; Molinengo, Giorgia; Ora, Josuel; Paggiaro, Pierluigi; Patella, Vincenzo; Pelaia, Girolamo; Pirina, Pietro; Proietto, Alfio; Rogliani, Paola; Santus, Pierachille; Scichilone, Nicola; Simioli, Francesca; Solidoro, Paolo; Terraneo, Silvia; Zuccon, Umberto; Canonica, Giorgio Walter
Asthma considerably impairs patients' quality of life and increases healthcare costs. Severity, morbidity, and degree of disease control are the major drivers of its clinical and economic impact. National scientific societies are required to monitor the application of international guidelines and to adopt strategies to improve disease control and better allocate resources. to provide a detailed picture of the characteristics of asthma patients and modalities of asthma management by specialists in Italy and to develop recommendations for the daily management of asthma in a specialist setting. A quantitative research program was implemented. Data were collected using an ad hoc questionnaire developed by a group of specialists selected by the Italian Pneumology Society/Italian Respiratory Society. The records of 557 patients were analyzed. In the next few years, specialists are expected to focus their activity patients with more severe disease and will be responsible for selection of patients for personalized biological therapy; however, only 20% of patients attending Italian specialist surgery can be considered severe. In 84.4% of cases, the visit was a follow-up visit requested in 82.2% of cases by the specialist him/herself. The Asthma Control Test is used only in 65% of patients. When available, a significant association has been observed between the test score and asthma control as judged by the physician, although concordance was only moderate (κ = 0.68). Asthma was considered uncontrolled by the specialist managing the case in 29.1% of patients; nevertheless, treatment was not stepped up in uncontrolled or partly controlled patients (modified in only 37.2% of patients). The results of this survey support re-evaluation of asthma management by Italian specialists. More resources should be made available for the initial visit and for more severely ill patients. In addition, more extensive use should be made of validated tools, and available drugs should be used
Patel, Minal R; Caldwell, Cleopatra H; Id-Deen, Effat; Clark, Noreen M
Despite economic hardship, compliance with self-management regimens is still evident among individuals and families managing chronic disease. The purpose of this study was to describe how women with asthma address cost-related challenges to management of their condition. In 2012 and 2013, four focus groups were conducted in Southeast Michigan with 26 African American women with asthma, recruited based on maximum variation sampling procedures. A semi-structured interview protocol was employed by trained facilitators. Coded transcripts were analyzed for themes regarding means to reduce the impact of the cost of asthma management. Major themes identified were acceptance of the status quo; stockpiling and sharing medicines; utilizing community assistance programs; reaching out to healthcare providers and social networks for help; foregoing self-management; and utilizing urgent care. Awareness of strategies that are helpful to patients in reducing out-of-pocket costs may better equip service providers and others to develop interventions to make useful strategies more widely available.
Grammatopoulou, Eirini; Skordilis, Emmanouil K; Haniotou, Aikaterini; John, Zarotis; Athanasopoulos, Spyros
The holistic self-management plan includes lifelong actions that enable patients to cope with their disease. The present study was designed to evaluate the effect of a holistic self-management plan on asthma control. A 12-month controlled study was conducted. Adult patients with mild-to-moderate asthma (n = 24) who attended the emergency asthma department were randomized to two groups: One group followed four educational sessions and three personal home sessions (n = 12), while a second group received a short manual with asthma information (n = 12). The main measure was the asthma control test (ACT), while secondary outcomes were self-efficacy (general self-efficacy scale, GSE), end-tidal carbon dioxide (ETCO 2 ), respiratory rate (RR), breathing hold time (BHT), the Nijmegen Questionnaire (NQ), and spirometry (FEV 1 % predicted (forced expiratory volume in 1 second % predicted)) scores. The 2 × 4 ANOVA showed a significant interaction effect between intervention and time in ACT (p = 0.001), GSE (p holistic self-management in asthma control. Behavioral changes, as indicated by the development of self-efficacy and the reduction of hyperventilation, contributed to the effectiveness of the intervention.
Ahmed, Sara; Bartlett, Susan J; Ernst, Pierre; Paré, Guy; Kanter, Maria; Perreault, Robert; Grad, Roland; Taylor, Laurel; Tamblyn, Robyn
Asthma is a prevalent and costly disease resulting in reduced quality of life for a large proportion of individuals. Effective patient self-management is critical for improving health outcomes. However, key aspects of self-management such as self-monitoring of behaviours and symptoms, coupled with regular feedback from the health care team, are rarely addressed or integrated into ongoing care. Health information technology (HIT) provides unique opportunities to facilitate this by providing a means for two way communication and exchange of information between the patient and care team, and access to their health information, presented in personalized ways that can alert them when there is a need for action. The objective of this study is to evaluate the acceptability and efficacy of using a web-based self-management system, My Asthma Portal (MAP), linked to a case-management system on asthma control, and asthma health-related quality of life. The trial is a parallel multi-centered 2-arm pilot randomized controlled trial. Participants are randomly assigned to one of two conditions: a) MAP and usual care; or b) usual care alone. Individuals will be included if they are between 18 and 70, have a confirmed asthma diagnosis, and their asthma is classified as not well controlled by their physician. Asthma control will be evaluated by calculating the amount of fast acting beta agonists recorded as dispensed in the provincial drug database, and asthma quality of life using the Mini Asthma Related Quality of Life Questionnaire. Power calculations indicated a needed total sample size of 80 subjects. Data are collected at baseline, 3, 6, and 9 months post randomization. Recruitment started in March 2010 and the inclusion of patients in the trial in June 2010. Self-management support from the care team is critical for improving chronic disease outcomes. Given the high volume of patients and time constraints during clinical visits, primary care physicians have limited time to
Kash, Bita A; Gamm, Larry D; Bolin, Jane Nelson; Peck, B Mitchell
Studies of disease management (DM) have shown that patients who participate in such programs achieve better health status and make fewer emergency room visits. Private and government payers have recently increased their efforts to promote DM initiatives through financial incentives to healthcare providers. This article explores opportunities for administrators of health services organizations (HSO) to promote DM in the current political and economic environment. Our survey of professionals (DM leaders, physicians, and DM nurses) in six DM programs reveals these professionals' assessments of the key players and resources that they deem important to their respective DM programs. They view DM programs as heavily dependent on the support of physicians, nurses, and health plan leaders but relatively less so on the support of HSO administrators- a situation that may suggest opportunities for administrators to take on greater leadership in moving the HSO toward developing DM programs. Survey results also indicate a strong need for the integration of resources such as communication systems, electronic medical records, and DM reporting. Taken collectively, these needs suggest a number of strategies for the administrator to play a larger role in supporting the adoption and effective implementation of DM. In the article, we propose that DM programs can benefit substantially from an administrator who can demonstrate a thorough knowledge of DM-related government and private-payer initiatives and who has the ability to provide leadership to develop and implement viable DM programs. Valued contributions that the administrator should bring to the table include support of standardized DM processes, use of practice guidelines, and provision of pertinent information systems.
Stelmach, Rafael; Neto, Alcindo Cerci; Fonseca, Ana Cristina de Carvalho Fernandez; Ponte, Eduardo Vieira; Alves, Gerardo; Araujo-Costa, Ildely Niedia; Lasmar, Laura Maria de Lima Belizário Facury; de Castro, Luci Keiko Kuromoto; Lenz, Maria Lucia Medeiros; Silva, Paulo; Cukier, Alberto; Alves, Alexssandra Maia; Lima-Matos, Aline Silva; Cardoso, Amanda da Rocha Oliveira; Fernandes, Ana Luisa Godoy; de São-José, Bruno Piassi; Riedi, Carlos Antônio; Schor, Deborah; Peixoto, Décio Medeiros; Brandenburg, Diego Djones; Camillo, Elineide Gomes dos Santos; Serpa, Faradiba Sarquis; Brandão, Heli Vieira; Lima, João Antonio Bonfadini; Pio, Jorge Eduardo; Fiterman, Jussara; Anderson, Maria de Fátima; Cardoso, Maria do Socorro de Lucena; Rodrigues, Marcelo Tadday; Pereira, Marilyn Nilda Esther Urrutia; Antila, Marti; Martins, Sonia Maria; Guimarães, Vanessa Gonzaga Tavares; Mello, Yara Arruda Marques; de Andrade, Wenderson Clay Correia; Salibe-Filho, William; Caldeira, Zelina Maria da Rocha; da Cruz-Filho, Álvaro Augusto Souza; Camargos, Paulo
Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero. PMID:25750669
Panzera, Anthony D; Schneider, Tali K; Martinasek, Mary P; Lindenberger, James H; Couluris, Marisa; Bryant, Carol A; McDermott, Robert J
Self-management of asthma can now leverage new media technologies. To optimize implementation they must employ a consumer-oriented developmental approach. This study explored benefits of and barriers to improved asthma self-management and identified key elements for the development of a digital media tool to enhance asthma control. Between August 2010 and January 2011, 18 teens with asthma and 18 parent-caregivers participated in semistructured in-depth interviews to identify mechanisms for improving asthma self-management and propose characteristics for developing a digital media tool to aid such efforts. Teens and caregivers enumerated physician-recommended strategies for asthma management as well as currently employed strategies. Both groups thought of a potential digital media solution as positive, but indicated specific design requirements for such a solution to have utility. Whereas most participants perceived mobile platforms to be viable modes to improve asthma self-management, interest in having social networking capabilities was mixed. A digital media product capable of tracking conditions, triggers, and related asthma activities can be a core element of improved asthma control for youth. Improved asthma control will help decrease school absenteeism. © 2013, American School Health Association.
Nicholson, P J; Cullinan, P; Taylor, A J Newman; Burge, P S; Boyle, C
Occupational asthma is the most frequently reported work related respiratory disease in many countries. This work was commissioned by the British Occupational Health Research Foundation to assist the Health and Safety Executive in achieving its target of reducing the incidence of occupational asthma in Great Britain by 30% by 2010. The guidelines aim to improve the prevention, identification, and management of occupational asthma by providing evidence based recommendations on which future practice can be based. The literature was searched systematically using Medline and Embase for articles published in all languages up to the end of June 2004. Evidence based statements and recommendations were graded according to the Royal College of General Practitioner's star system and the revised Scottish Intercollegiate Guidelines Network grading system. A total of 474 original studies were selected for appraisal from over 2500 abstracts. The systematic review produced 52 graded evidence statements and 22 recommendations based on 223 studies. Evidence based guidelines have become benchmarks for practice in healthcare and the process used to prepare them is well established. This evidence review and its recommendations focus on interventions and outcomes to provide a robust approach to the prevention, identification, and management of occupational asthma, based on and using the best available medical evidence. The most important action to prevent cases of occupational asthma is to reduce exposure at source. Thereafter surveillance should be performed for the early identification of symptoms, including occupational rhinitis, with additional functional and immunological tests where appropriate. Effective management of workers suspected to have occupational asthma involves the identification and investigation of symptoms suggestive of asthma immediately they occur. Those workers who are confirmed to have occupational asthma should be advised to avoid further exposure completely
Choong, Miew Keen; Tsafnat, Guy; Hibbert, Peter; Runciman, William B; Coiera, Enrico
Clinical quality indicators are used to monitor the performance of healthcare services and should wherever possible be based on research evidence. Little is known however about the extent to which indicators in common use are based on research. The objective of this study is to measure the extent to which clinical quality indicators used in asthma management in children with outcome measurements can be linked to results in randomised controlled clinical trial (RCT) reports. This work is part of a broader research program to trial methods that improve the efficiency and accuracy of indicator development. National-level indicators for asthma management in children were extracted from the National Quality Measures Clearinghouse database and the National Institute for Health and Care Excellence quality standards by two independent appraisers. Outcome measures were extracted from all published English language RCT reports for asthma management in children below the age of 12 published between 2005 and 2014. The two sets were then linked by manually mapping both to a common set of Unified Medical Language System (UMLS) concepts. The analysis identified 39 indicators and 562 full text RCTs dealing with asthma management in children. About 95% (37/39) of the indicators could be linked to RCT outcome measures. It is possible to identify relevant RCT reports for the majority of indicators used to assess the quality of asthma management in childhood. The methods reported here could be automated to more generally support assessment of candidate indicators against the research evidence.
Maciejewski, Matthew L; Chen, Shih-Yin; Au, David H
Disease management has been implemented for patients with asthma in various ways. We describe the approaches to and components of adult asthma disease-management interventions, examine the outcomes evaluated, and assess the quality of published studies. We searched the MEDLINE, EMBASE, CINAHL, PsychInfo, and Cochrane databases for studies published in 1986 through 2008, on adult asthma management. With the studies that met our inclusion criteria, we examined the clinical, process, medication, economic, and patient-reported outcomes reported, and the study designs, provider collaboration during the studies, and statistical methods. Twenty-nine articles describing 27 studies satisfied our inclusion criteria. There was great variation in the content, extent of collaboration between physician and non-physician providers responsible for intervention delivery, and outcomes examined across the 27 studies. Because of limitations in the design of 22 of the 27 studies, the differences in outcomes assessed, and the lack of rigorous statistical adjustment, we could not draw definitive conclusions about the effectiveness or cost-effectiveness of the asthma disease-management programs or which approach was most effective. Few well-designed studies with rigorous evaluations have been conducted to evaluate disease-management interventions for adults with asthma. Current evidence is insufficient to recommend any particular intervention.
Foster, T.; Brozovic, N.; Butler, A. P.
To date, there has been little attention focused on how the value and effectiveness of groundwater management is influenced by the timing of regulatory intervention relative to aquifer depletion. To address this question, we develop an integrated framework that couples an agro-economic model of farmers' field-level irrigation decision-making with a model of a groundwater abstraction borehole. Unlike existing models that only consider the impact of aquifer depletion on groundwater extraction costs, our model also captures the dynamic changes in well productivity and how these in turn affect crop yields and farmer incomes. We use our model to analyze how the value of imposing groundwater quotas is affected by the prior level of depletion before regulations are introduced. Our results demonstrate that there is a range of aquifer conditions within which regulating groundwater use will deliver long-term economic benefits for farmers. In this range, restricting abstraction rates slows the rate of change in well yields and, as a result, increases agricultural production over the simulated planning horizon. Contrastingly, when current saturated thickness is outside this range, regulating groundwater use will provide negligible social benefits and will impose large negative impacts on farm-level profits. We suggest that there are 'windows of opportunity' for managing aquifer depletion that are a function of local hydrology as well as economic characteristics. Regulation that is too early will harm the rural economy needlessly, while regulation that is too late will be unable to prevent aquifer exhaustion. The insights from our model can be a valuable tool to help inform policy decisions about when, and at what level, regulations should be implemented in order to maximize the benefits obtained from limited groundwater resources.
Hosseini, Anahita; Buonocore, Chris M; Hashemzadeh, Sepideh; Hojaiji, Hannaneh; Kalantarian, Haik; Sideris, Costas; Bui, Alex A T; King, Christine E; Sarrafzadeh, Majid
To address the need for asthma self-management in pediatrics, the authors present the feasibility of a mobile health (mHealth) platform built on their prior work in an asthmatic adult and child. Real-time asthma attack risk was assessed through physiological and environmental sensors. Data were sent to a cloud via a smartwatch application (app) using Health Insurance Portability and Accountability Act (HIPAA)-compliant cryptography and combined with online source data. A risk level (high, medium or low) was determined using a random forest classifier and then sent to the app to be visualized as animated dragon graphics for easy interpretation by children. The feasibility of the system was first tested on an adult with moderate asthma, then usability was examined on a child with mild asthma over several weeks. It was found during feasibility testing that the system is able to assess asthma risk with 80.10 ± 14.13% accuracy. During usability testing, it was able to continuously collect sensor data, and the child was able to wear, easily understand and enjoy the use of the system. If tested in more individuals, this system may lead to an effective self-management program that can reduce hospitalization in those who suffer from asthma.
Gold, Diane R; Adamkiewicz, Gary; Arshad, Syed Hasan; Celedón, Juan C; Chapman, Martin D; Chew, Ginger L; Cook, Donald N; Custovic, Adnan; Gehring, Ulrike; Gern, James E; Johnson, Christine C; Kennedy, Suzanne; Koutrakis, Petros; Leaderer, Brian; Mitchell, Herman; Litonjua, Augusto A; Mueller, Geoffrey A; O'Connor, George T; Ownby, Dennis; Phipatanakul, Wanda; Persky, Victoria; Perzanowski, Matthew S; Ramsey, Clare D; Salo, Päivi M; Schwaninger, Julie M; Sordillo, Joanne E; Spira, Avrum; Suglia, Shakira F; Togias, Alkis; Zeldin, Darryl C; Matsui, Elizabeth C
Environmental exposures have been recognized as critical in the initiation and exacerbation of asthma, one of the most common chronic childhood diseases. The National Institute of Allergy and Infectious Diseases; National Institute of Environmental Health Sciences; National Heart, Lung, and Blood Institute; and Merck Childhood Asthma Network sponsored a joint workshop to discuss the current state of science with respect to the indoor environment and its effects on the development and morbidity of childhood asthma. The workshop included US and international experts with backgrounds in allergy/allergens, immunology, asthma, environmental health, environmental exposures and pollutants, epidemiology, public health, and bioinformatics. Workshop participants provided new insights into the biologic properties of indoor exposures, indoor exposure assessment, and exposure reduction techniques. This informed a primary focus of the workshop: to critically review trials and research relevant to the prevention or control of asthma through environmental intervention. The participants identified important limitations and gaps in scientific methodologies and knowledge and proposed and prioritized areas for future research. The group reviewed socioeconomic and structural challenges to changing environmental exposure and offered recommendations for creative study design to overcome these challenges in trials to improve asthma management. The recommendations of this workshop can serve as guidance for future research in the study of the indoor environment and on environmental interventions as they pertain to the prevention and management of asthma and airway allergies. Published by Elsevier Inc.
M Diane Lougheed
Full Text Available BACKGROUND: In 2010, the Canadian Thoracic Society (CTS published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and/or gaps in the previous guidelines.
Gibson-Scipio, Wanda; Krouse, Helene J
Caregiver goals, an integral part of a partnership for asthma management, have been found to influence asthma outcomes in children. These goals are likely to change during the transitional period of adolescence to address the needs of teenagers as they mature and assume greater responsibilities for their own care. Little is known about the goals, beliefs, and concerns of caregivers as they begin to shift responsibilities for asthma management to teens. This study sought to identify the asthma management goals, beliefs, and concerns of primarily African American caregivers of urban middle and older adolescents. Fourteen caregivers of urban African American adolescents aged 14-18 years with asthma participated in a focus group session. An iterative process was used to identify themes from the session related to asthma management goals, concerns, and beliefs of caregivers. Caregivers identified goals that related to supporting their teens' progress toward independent asthma self-management. They described significant concerns related to the teens' ability to implement asthma self-management, especially in school settings. Caregivers also revealed beliefs that represented knowledge deficits related to asthma medications and factors that improved or worsened asthma. Most caregivers identified grave concerns about school policies regarding asthma medication administration and the lack of knowledge and support provided by teachers and staff for their teen. Caregivers are an invaluable resource in the care of adolescents with asthma. An opportunity exists to improve caregiver understanding of asthma medications and to provide support through improvements in asthma care for adolescents in school-based settings.
Price, David; Hillyer, Elizabeth V.; van der Molen, Thys
Purpose of review Randomized controlled trials, known as efficacy trials and long considered the gold standard for evidence-based asthma guidelines, are designed to test whether interventions have a benefit for selective patient populations under ideal conditions. The goal of pragmatic trials and
World‑wide, it is estimated that 300 million people are affected with bronchial asthma. .... years of study, design, the focus of the challenge (diagnosis, treatment .... nebulizer for delivering large bronchodilator doses in patients with severe acute ..... Limitations UK Findings, poster presented at the British. Thoracic Society.
Rix, Iben; Håkansson, Kåre; Larsen, Christian Grønhøj
of the evidence for each outcome was graded on the basis of study quality and consistency in findings. RESULTS: We included seven trials in which the effect of montelukast, omalizumab, erythromycin, and functional endoscopic sinus surgery (FESS) were studied in 317 adults with CRSwNP and asthma. All...
Full Text Available Girolamo Pelaia1, Luca Gallelli1, Teresa Renda1, Pasquale Romeo1, Maria Teresa Busceti1, Rosa Daniela Grembiale1, Rosario Maselli1, Serafino Antonio Marsico2, Alessandro Vatrella31Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro; 2Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples; 3Department of Respiratory Medicine, University of Salerno, Salerno, ItalyAbstract: Omalizumab is a humanized monoclonal anti-IgE antibody recently approved for the treatment of severe allergic asthma. This drug inhibits allergic responses by binding to serum IgE, thus preventing interaction with cellular IgE receptors. Omalizumab is also capable of downregulating the expression of high affinity IgE receptors on inflammatory cells, as well as the numbers of eosinophils in both blood and induced sputum. The clinical effects of omalizumab include improvements in respiratory symptoms and quality of life, paralleled by a reduction of asthma exacerbations, emergency room visits, and use of systemic corticosteroids and rescue bronchodilators. Omalizumab is relatively well-tolerated, and only rarely induces anaphylactic reactions. Therefore, this drug represents a valid option as add-on therapy for patients with severe persistent allergic asthma inadequately controlled by high doses of standard inhaled treatments.Keywords: omalizumab, anti-IgE, severe asthma
Wang, W Q; Lin, J T; Zhou, X; Wang, C Z; Huang, M; Cai, S X; Chen, P; Lin, Q C; Zhou, J Y; Gu, Y H; Yuan, Y D; Sun, D J; Yang, X H; Yang, L; Huo, J M; Chen, Z C; Jiang, P; Zhang, J; Ye, X W; Liu, H G; Tang, H P; Liu, R Y; Liu, C T; Zhang, W; Hu, C P; Chen, Y Q; Liu, X J; Dai, L M; Zhou, W; Huang, Y J; Xu, J Y
Objective: To evaluate the general level of asthma management in urban areas of China and further promote the national asthma management plan. Methods: A multi-center, cross-sectional survey was carried out in 30 provinces of China (except for Tibet) during Oct 2015 to May 2016. It's a questionnaire-based face-to-face survey which included asthma management using peak flow meter (PFM) and pulmonary function test, medication choice of maintenance therapy and asthma education. Results: A total of 3 875 asthmatic outpatients were recruited including 2 347(60.6%) females and 1 528(39.4%) males. The mean age was (50.7±16.7) years ranging from 14 to 99. Only 10.1%(388/3 837) patients used PFM as monitoring, whereas 62.1%(2 405/3 874) patients underwent pulmonary function test during the past year. There were 57.4%(2 226/3 875) patients treated with inhaled cortical steroid plus long-acting β(2)-agonist combinations (ICS+LABA) as daily medication. 43.3%(1 661/3 836) patients were followed up by physicians. Among this population, 1 362 asthmatic outpatients were recruited, who also took part in the asthma control survey in 2007-2008 in 10 cities. In this subgroup, 17.9%(244/1 360) were tested by PFM and 66.6%(907/1 362) by pulmonary function test during last year. As to the medication, 63.1%(860/1 362) selected ICS+LABA for daily control. There were 50.4%(685/1 359) patients in the follow-up cohort by physicians. Compared to the similar survey conducted in 2007-2008, the proportion of patients with ICS+LABA regimen and follow-up by physicians were markedly higher, while the rate of PFM use did not have significant improvement. Conclusion: Although the present level of asthma management in China is still far from ideal, asthma management has improved compared to 8 years ago. Yet the use of PFM does not significantly improve. Asthma action plan and application of PFM should be further promoted to improve the level of asthma management.
Smith, Lorraine; Bosnic-Anticevich, Sinthia Z; Mitchell, Bernadette; Saini, Bandana; Krass, Ines; Armour, Carol
Asthma affects a considerable proportion of the population worldwide and presents a significant health problem in Australia. Given its chronic nature, effective asthma self-management approaches are important. However, despite research and interventions targeting its treatment, the management of asthma remains problematic. This study aimed to develop, from a theoretical basis, an asthma self-management model and implement it in an Australian community pharmacy setting in metropolitan Sydney, using a controlled, parallel-groups repeated-measures design. Trained pharmacists delivered a structured, step-wise, patient-focused asthma self-management program to adult participants over a 9-month period focusing on identification of asthma problems, goal setting and strategy development. Data on process- clinical- and psychosocial-outcome measures were gathered. Results showed that participants set an average of four new goals and six repeated goals over the course of the intervention. Most common goal-related themes included asthma triggers, asthma control and medications. An average of nine strategies per participant was developed to achieve the set goals. Common strategies involved visiting a medical practitioner for review of medications, improving adherence to medications and using medications before exercise. Clinical and psychosocial outcomes indicated significant improvements over time in asthma symptom control, asthma-related self-efficacy and quality of life, and negative affect. These results suggest that an asthma self-management model of illness behaviour has the potential to provide patients with a range of process skills for self-management, and deliver improvements in clinical and psychosocial indicators of asthma control. The results also indicate the capacity for the effective delivery of such an intervention by pharmacists in Australian community pharmacy settings.
van der Meer, Victor; Bakker, Moira J.; van den Hout, Wilbert B.; Rabe, Klaus F.; Sterk, Peter J.; Kievit, Job; Assendelft, Willem J. J.; Sont, Jacob K.; Assendelft, W. J. J.; Thiadens, H. A.; Bakker, M. J.; van den Hout, W. B.; Kievit, J.; van der Meer, V.; Sont, J. K.; Kaptein, A. A.; Rikkers-Mutsaerts, E. R. V. M.; Rabe, K. F.; Bel, E. H. D.; Detmar, S. B.; Otten, W.; van Stel, H. F.; Roldaan, A. C.; de Jongste, J. C.; Toussaint, P. J.
BACKGROUND: The Internet may support patient self-management of chronic conditions, such as asthma. OBJECTIVE: To evaluate the effectiveness of Internet-based asthma self-management. DESIGN: Randomized, controlled trial. SETTING: 37 general practices and 1 academic outpatient department in the
Full Text Available Type-2/eosinophilic inflammation plays a pivotal role in asthma. The identification of severe type-2/eosinophilic asthma is important for improving the management of patients with asthma. Therefore, efforts to develop non-invasive biomarkers for type-2/eosinophilic airway inflammation have been made during this decade. Currently, fraction of exhaled nitric oxide (FeNO and serum periostin levels are considered markers of type-2/eosinophilic inflammation in asthma. However, a single-marker approach has limited the ability to diagnose severe type-2/eosinophilic asthma accurately and predict disease outcomes precisely. The present article reviews the utility of FeNO and serum periostin levels in a single-marker approach and in a multiple-marker approach in identifying patients with severe type-2/eosinophilic asthma. Furthermore, based on a sub-analysis of the Kinki Hokuriku Airway disease Conference (KiHAC, geno-endo-phenotypes of patients were stratified into four groups according to the FeNO and serum periostin levels.
Galbreath, Autumn Dawn; Smith, Brad; Wood, Pamela R; Inscore, Stephen; Forkner, Emma; Vazquez, Marilu; Fallot, Andre; Ellis, Robert; Peters, Jay I
The goal of disease management (DM) is to improve health outcomes and reduce cost through decreasing health care utilization. Although some studies have shown that DM improves asthma outcomes, these interventions have not been examined in a large randomized controlled trial. To compare the effectiveness of 2 previously successful DM programs with that of traditional care. Nine hundred two individuals with asthma (429 adults; 473 children) were randomly assigned to telephonic DM, augmented DM (ADM; DM plus in-home visits by a respiratory therapist), or traditional care. Data were collected at enrollment and at 6 and 12 months. Primary outcomes were time to first asthma-related event, quality of life (QOL), and rates of asthma-related health care utilization. Secondary outcomes included rate of controller medication initiation, number of oral corticosteroid bursts, asthma symptom scores, and number of school days missed. There were no significant differences between groups in time to first asthma-related event or health care utilization. Adult participants in the ADM group had greater improvement in QOL (P = .04) and a decrease in asthma symptoms (P = .001) compared with other groups. Of children not receiving controller medications at enrollment (13%), those in the intervention groups were more likely to have controller medications initiated than the control group (P = .01). Otherwise, there were no differences in outcomes. Overall, participation in asthma DM did not result in significant differences in utilization or clinical outcomes. The only significant impact was a higher rate of controllermedication initiation in children and improvement in asthma symptoms and QOL in adults who received ADM.
Klinnert, Mary D.; Holsey, Chanda Nicole; McQuaid, Elizabeth L.
Objective To examine the reliability and validity of the Family Asthma Management System Scale for low-income African-American children with poor asthma control and caregivers under stress. The FAMSS assesses eight aspects of asthma management from a family systems perspective. Methods Forty-three children, ages 8–13, and caregivers were interviewed with the FAMSS; caregivers completed measures of primary care quality, family functioning, parenting stress, and psychological distress. Children rated their relatedness with the caregiver, and demonstrated inhaler technique. Medical records were reviewed for dates of outpatient visits for asthma. Results The FAMSS demonstrated good internal consistency. Higher scores were associated with adequate inhaler technique, recent outpatient care, less parenting stress and better family functioning. Higher scores on the Collaborative Relationship with Provider subscale were associated with greater perceived primary care quality. Conclusions The FAMSS demonstrated relevant associations with asthma management criteria and family functioning for a low-income, African-American sample. PMID:19776230
Yoo, Woohyun; Kim, Soo Yun; Hong, Yangsun; Chih, Ming-Yuan; Shah, Dhavan V; Gustafson, David H
With the increasing penetration of digital mobile devices among adolescents, mobile texting messaging is emerging as a new channel for patient-clinician communication for this population. In particular, it can promote active communication between healthcare clinicians and adolescents with asthma. However, little is known about the content of the messages exchanged in medical encounters via mobile text messaging. Therefore, this study explored the content of text messaging between clinicians and adolescents with asthma. We collected a total of 2,953 text messages exchanged between 5 nurse case managers and 131 adolescents with asthma through a personal digital assistant. The text messages were coded using a scheme developed by adapting categories from the Roter Interaction Analysis System. Nurse case managers sent more text messages (n=2,639) than adolescents with asthma. Most messages sent by nurse case managers were targeted messages (n=2,475) directed at all adolescents with asthma, whereas there were relatively few tailored messages (n=164) that were created personally for an individual adolescent. In addition, both targeted and tailored messages emphasized task-focused behaviors over socioemotional behaviors. Likewise, text messages (n=314) sent by adolescents also emphasized task-focused over socioemotional behaviors. Mobile texting messaging has the potential to play an important role in patient-clinician communication. It promotes not only active interaction, but also patient-centered communication with clinicians. In order to achieve this potential, healthcare clinicians may need to focus on socioemotional communication as well as task-oriented communication.
Hanna, Tamer; Bajorek, Beata; Lemay, Kate; Armour, Carol L
Full Text Available Opportunizing emerged as the core variable of this classic GT study on business and management. Opportunizing is the recurrent main concern that businesses have to continually resolve, and it explains how companies recurrently create, identify, seize or exploit situations to maintain their growth or survival. Opportunizing is the recurrent creation and re-creation of opportunities in business. Opportunizing is basically what business managers do and do all the time. The problematic nature of opportunizing is resolved by a core social process ofopportunizing and its attached sub-processes that account for change over time and for the variations of the problematic nature of its resolution.Opportunizing has five main facets. These are conditional befriending (confidence building & modifying behavior,prospecting (e.g. information gaining, weighing up (information appraisal & decision-making, moment capturing (quick intervention for seizing strategic opportunities, andconfiguration matching (adjusting the business organization to abet the other activities of opportunizing.On a more abstract level, opportunizing has three more organizational facets: the physically boundary-less, the valuehierarchical, and the physically bounded. The first of these called perpetual opportunizing. This emerges from the conjunction of conditional befriending and prospecting. The second facet is called triggering opportunizing. It arises from the coming together of weighing up and moment capturing. The final facet is called spasmodic opportunizing. This happens when moment capturing and configuration matching unite.
Shuler, Melinda S; Yeatts, Karin B; Russell, Donald W; Trees, Amy S; Sutherland, Susan E
A substantial proportion of low-income children with asthma living in rural western North Carolina have suboptimal asthma management. To address the needs of these underserved children, we developed and implemented the Regional Asthma Disease Management Program (RADMP); RADMP was selected as one of 13 demonstration projects for the National Asthma Control Initiative (NACI). This observational intervention was conducted from 2009 to 2011 in 20 rural counties and the Eastern Band Cherokee Indian Reservation in western North Carolina. Community and individual intervention components included asthma education in-services and environmental assessments/remediation. The individual intervention also included clinical assessment and management. Environmental remediation was conducted in 13 childcare facilities and 50 homes; over 259 administrative staff received asthma education. Fifty children with mild to severe persistent asthma were followed for up to 2 years; 76% were enrolled in Medicaid. From 12-month pre-intervention to 12-month post-intervention, the total number of asthma-related emergency department (ED) visits decreased from 158 to 4 and hospital admissions from 62 to 1 (p < 0.0001). From baseline to intervention completion, lung function FVC, FEV1, FEF 25-75 increased by 7.2%, 13.2% and 21.1%, respectively (all p < 0.001), and average school absences dropped from 17 to 8.8 days. Healthcare cost avoided 12 months post-intervention were approximately $882,021. The RADMP program resulted in decreased ED visits, hospitalizations, school absences and improved lung function and eNO. This was the first NACI demonstration project to show substantial improvements in healthcare utilization and clinical outcomes among rural asthmatic children.
... - about $200 million annually. Systemic, integrated solutions offer the Army a great opportunity to save millions of dollars annually in repair and replacement costs, and to avoid incidental costs incurred due to interrupted...
Windt, Roland; Glaeske, Gerd
The purpose of this study was to assess outcomes of a nationwide asthma disease management (DM) program in Germany. A retrospective observational study with propensity-score matching was performed using claims data of sickness funds exclusively. Effects were analyzed on the basis of a match of 317 program participants and nonparticipants with similar propensity score and age. Hospitalization or oral corticosteroid user rates were comparable in both groups, whereas there are significantly more subjects in the DM group with a prescription of an inhaled corticosteroid and fewer with a prescription of a cromolyn/reproterol combination. There are also less "doctor hoppers" in the DM group, defined as subjects with antiasthmatic drug prescriptions of at least three physicians. The results suggest that the impact of a nationwide disease management program for asthma is weak in respect of clinically relevant endpoints, but there are indications that medication in a DM program approximates asthma guidelines more closely.
Muniz Janaína Barbosa
Full Text Available Asthma results from a combination of three essential features: airflow obstruction, hyperresponsiveness of airways to endogenous or exogenous stimuli and inflammation. Inadequacy of the techniques to use different inhalation devices is one of the causes of therapeutic failure. The main purpose of this study was to evaluate how 20 medical students, 36 resident physicians of Internal Medicine/Pediatrics, and 40 asthma patients used three devices for inhalation therapy containing placebo. All patients were followed at the Pulmonary Outpatient Service of Botucatu Medical School and had been using inhaled medication for at least six months. The following devices were evaluated: metered dose inhalers (MDI, dry powder inhalers (DPI, and MDI attached to a spacer device. A single observer applied a protocol containing the main steps necessary to obtain a good inhaler technique to follow and grade the use of different devices. Health care professionals tested all three devices and patients tested only the device being used on their management. MDI was the device best known by doctors and patients. MDI use was associated with errors related to the coordination between inspiration and device activation. Failure to exhale completely before inhalation of the powder was the most frequent error observed with DPI use. In summary, patients did not receive precise instruction on how to use inhaled medication and health care professionals were not well prepared to adequately teach their patients.
Global estimates on ageing predict an increased burden of asthma in the older population. Consequently, its recognition, diagnosis and management in clinical practice require optimization. This review aims to provide an update for clinicians highlighting advances in the understanding of the ageing process and immunosenescence together with their applicability to asthma from a diagnostic and therapeutic perspective. Ageing impacts airway responses, immune function and influences efficacy of emerging phenotype-specific therapies when applied to the elderly patient. Differentiating eosinophilic and neutrophilic disease accounts for atopic illness and distinguishes long-standing from late-onset asthma. Therapeutic challenges in drug delivery, treatment adherence and side effect profiles persist in the older patient while novel recording devices developed to aid detection of an adequate inhalation evaluates treatment effectiveness and compliance more accurately than previously attainable. Anti-cytokine therapies improve control of brittle asthma while bronchial thermoplasty is an option in refractory cases. Multi-dimensional intervention strategies prove best in the management of asthma in the older adult which remains a condition that is not rare but rarely diagnosed in this patient population.
Morrison, Deborah; Mair, Frances S; Chaudhuri, Rekha; McGee-Lennon, Marilyn; Thomas, Mike; Thomson, Neil C; Yardley, Lucy; Wyke, Sally
Around 300 million people worldwide have asthma and prevalence is increasing. Self-management can be effective in improving a range of outcomes and is cost effective, but is underutilised as a treatment strategy. Supporting optimum self-management using digital technology shows promise, but how best to do this is not clear. We aimed to develop an evidence based, theory informed, online resource to support self-management in adults with asthma, called 'Living well with Asthma', as part of the RAISIN (Randomized Trial of an Asthma Internet Self-Management Intervention) study. We developed Living well with Asthma in two phases. Phase 1: A low fidelity prototype (paper-based) version of the website was developed iteratively through input from a multidisciplinary expert panel, empirical evidence from the literature, and potential end users via focus groups (adults with asthma and practice nurses). Implementation and behaviour change theories informed this process. Phase 2: The paper-based designs were converted to a website through an iterative user centred process. Adults with asthma (n = 10) took part in think aloud studies, discussing the paper based version, then the web-based version. Participants considered contents, layout, and navigation. Development was agile using feedback from the think aloud sessions immediately to inform design and subsequent think aloud sessions. Think aloud transcripts were also thematically analysed, further informing resource development. The website asked users to aim to be symptom free. Key behaviours targeted to achieve this include: optimising medication use (including inhaler technique); attending primary care asthma reviews; using asthma action plans; increasing physical activity levels; and stopping smoking. The website had 11 sections, plus email reminders, which promoted these behaviours. Feedback on the contents of the resource was mainly positive with most changes focussing on clarification of language, order of pages and
Full Text Available Robert Barrons,1 James Wheeler,2 J Andrew Woods1 1Wingate University School of Pharmacy, Wingate, NC, USA; 2University of Tennessee Health Science Center, Nashville, TN, USA Abstract: An anticipated surge in the elderly population will be accompanied by a rise in aging patients with asthma or COPD. Clinician selection of inhalers needs to address the unique challenges to elderly patients. These challenges to the use of inhalers include diminished physical and cognitive abilities, as well as cost reimbursement issues associated with polypharmacy and the Medicare gap. Clinicians should consider patient preferences for an inhaler device that provides ease of administration, and addresses conveniences such as portability, visual, and auditory indicators of dosing completion. The addition of spacer devices resolves hand-breath coordination difficulty with pressurized metered dose inhalers, but reduces overall inhaler convenience. Soft mist inhalers (Respimat® improve ease of administration, but use may be limited by cost and formulary availability. Multiple dose dry powder inhalers provide convenience and simplified use by requiring only one to two steps prior to administration, but concerns of peak inspiratory flow requirements remain among patients with advanced age and severity of COPD. If unaddressed, these challenges to inhaler selection contribute to inappropriate use of inhalers in 41% to 69% of patients, accompanied by at least 51% non-adherence to treatment. Clinicians must first avail themselves of reputable educational resources regarding new inhaler developments and administration, for competent patient instruction. Patient education should include a checklist of inhaler technique, with physical demonstration of each device by the patient and provider. Device demonstration significantly improves inhaler technique and identifies the need for nebulization therapy. Clinician and patient knowledge of available inhalers and their
Smith, Lorraine; Alles, Chehani; Lemay, Kate; Reddel, Helen; Saini, Bandana; Bosnic-Anticevich, Sinthia; Emmerton, Lynne; Stewart, Kay; Burton, Debbie; Krass, Ines; Armour, Carol
Goal setting was investigated as part of an implementation trial of an asthma management service (PAMS) conducted in 96 Australian community pharmacies. Patients and pharmacists identified asthma-related issues of concern to the patient and collaboratively set goals to address these. Although goal setting is commonly integrated into disease state management interventions, the nature of goals, and their contribution to goal attainment and health outcomes are not well understood. To identify and describe: 1) goals set collaboratively between adult patients with asthma and their pharmacist, 2) goal specificity and goal achievement, and 3) describe the relationships between specificity, achievement, asthma control and asthma-related quality of life. Measures of goal specificity, and goal achievement were developed and applied to patient data records. Goals set were thematically analyzed into goal domains. Proportions of goals set, goals achieved and their specificity were calculated. Correlational and regression analyses were undertaken to determine the relationships between goal specificity, goal achievement, asthma control and asthma-related quality of life. Data were drawn from 498 patient records. Findings showed that patients set a wide range and number of asthma-related goals (N = 1787) and the majority (93%) were either achieved or being working toward by the end of the study. Goal achievement was positively associated with specific and moderately specific goals, but not non-specific goals. However, on closer inspection, an inconsistent pattern of relationships emerged as a function of goal domain. Findings also showed that goal setting was associated with end-of-study asthma control but not to asthma-related quality of life. Pharmacists can help patients to set achievable and specific asthma management goals, and these have the potential to directly impact health outcomes such as asthma control. Goal specificity appears to be an important feature in the
Bosnic-Anticevich, Sinthia; Kritikos, Vicky; Carter, Victoria; Yan, Kwok Yin; Armour, Carol; Ryan, Dermot; Price, David
The first aim of the study (i) assess the current asthma status of general-practitioner-managed patients receiving regular fixed-dose combination inhaled corticosteroid and long-acting beta 2 agonist (FDC ICS/LABA) therapy and (ii) explore patients' perceptions of asthma control and attitudes/behaviors regarding preventer inhaler use. A cross-sectional observational study of Australian adults with a current physician diagnosis of asthma receiving ≥2 prescriptions of FDC ICS/LABA therapy in the previous year, who were recruited through general practice to receive a structured in-depth asthma review between May 2012 and January 2014. Descriptive statistics and Chi-Square tests for independence were used for associations across asthma control levels. Only 11.5% of the patients had controlled asthma based on guideline-defined criteria. Contrarily, 66.5% of the patients considered their asthma to be well controlled. Incidence of acute asthma exacerbations in the previous year was 26.5% and 45.6% of the patients were without a diagnosis of rhinitis. Asthma medication use and inhaler technique were sub-optimal; only 41.0% of the preventer users reported everyday use. The side effects of medication were common and more frequently reported among uncontrolled and partially controlled patients. The study revealed the extent to which asthma management needs to be improved in this patient cohort and the numerous unmet needs regarding the current state of asthma care. Not only there is a need for continuous education of patients, but also education of health care practitioners to better understand the way in which patient's perceptions impact on asthma management practices, incorporating these findings into clinical decision making.
Tinschert, Peter; Jakob, Robert; Barata, Filipe; Kramer, Jan-Niklas
Background Effective disease self-management lowers asthma’s burden of disease for both individual patients and health care systems. In principle, mobile health (mHealth) apps could enable effective asthma self-management interventions that improve a patient’s quality of life while simultaneously reducing the overall treatment costs for health care systems. However, prior reviews in this field have found that mHealth apps for asthma lack clinical evaluation and are often not based on medical guidelines. Yet, beyond the missing evidence for clinical efficacy, little is known about the potential apps might have for improving asthma self-management. Objective The aim of this study was to assess the potential of publicly available and well-adopted mHealth apps for improving asthma self-management. Methods The Apple App store and Google Play store were systematically searched for asthma apps. In total, 523 apps were identified, of which 38 apps matched the selection criteria to be included in the review. Four requirements of app potential were investigated: app functions, potential to change behavior (by means of a behavior change technique taxonomy), potential to promote app use (by means of a gamification components taxonomy), and app quality (by means of the Mobile Application Rating Scale [MARS]). Results The most commonly implemented functions in the 38 reviewed asthma apps were tracking (30/38, 79%) and information (26/38, 68%) functions, followed by assessment (20/38, 53%) and notification (18/38, 47%) functions. On average, the reviewed apps applied 7.12 of 26 available behavior change techniques (standard deviation [SD]=4.46) and 4.89 of 31 available gamification components (SD=4.21). Average app quality was acceptable (mean=3.17/5, SD=0.58), whereas subjective app quality lied between poor and acceptable (mean=2.65/5, SD=0.87). Additionally, the sum scores of all review frameworks were significantly correlated (lowest correlation: r36=.33, P=.04 between
Nielsen, Sven Hvid
It is commonplace these days to say that knowledge is the most critical asset to be managed. Yet not many people - particularly not practitioners - invest very much time in learning about what knowledge really is and how different knowledge management (KM) is from information management (IM...
Perez, Maria Gabriela; Feldman, Lya; Caballero, Fernan
Evaluates the effects of a self-management educational program on 29 children and their parents. Program consists of six sessions of information giving and cognitive-behavioral strategies for the children, and two talks and a brochure for the parents. Results indicate a significant effect on children's asthma knowledge and practice of…
Kosse, R.C.; Bouvy, M.L.; de Vries, T.W.; Kaptein, A.A.; Geers, H.C.J.; van Dijk, Liset; Koster, E.S.
Purpose: Poor medication adherence in adolescents with asthma results in poorly controlled disease and increased morbidity. The aim of the ADolescent Adherence Patient Tool (ADAPT) study is to develop an mHealth intervention to support self-management and to evaluate the effectiveness in improving
Kosse, R.C.; Bouvy, M.L.; Vries, T.W. de; Kaptein, A.A.; Geers, H.C.J.; Dijk, L. van; Koster, E.S.
Purpose: Poor medication adherence in adolescents with asthma results in poorly controlled disease and increased morbidity. The aim of the ADolescent Adherence Patient Tool (ADAPT) study is to develop an mHealth intervention to support self-management and to evaluate the effectiveness in improving
Lagerlov, P; Veninga, CCM; Muskova, M; Hummers-Pradier, E; Lundborg, CS; Andrew, M; Haaijer-Ruskamp, FM; DEP-group, [No Value
The aim of the study was to examine the relationship between guideline recommendations on asthma management, and the performance of doctors in five different European health care contexts, Knowledge, attitudes and prescribing behaviour of doctors recruited to an educational project was investigated.
Full Text Available Part of our daily lives, risk ceased to be just something that managers are desperate to alleviate if not eliminate. It is now rightfully considered a path to explore new opportunities. The last version of the ISO 9001, the 2015 edition, is asking from organization implementing it to determine the risk and opportunities associated with their main processes, the impact over relevant third parties and the context, both internal and external. With this duality as starting point, we have investigated among SME's implementing a quality management system what would they consider to be the risk and opportunities associated to this action. Our paper presents hereinafter the partial results of a wider study on Romanian SME's management, especially the findings related to what managers consider as risk or opportunity when implementing a quality management system.
Sverrild, Asger; Porsbjerg, Celeste; Backer, Vibeke
on inhaled mannitol from the first publication in 1997 until present (October 2011). It discusses the current knowledge on the clinical usefulness as a tool for diagnosing and managing asthma. EXPERT OPINION: Inhaled mannitol can be regarded as a safe, standardized, specific, but less sensitive, tool...... for the diagnosis of asthma in both children and adults. Discomfort, in terms of cough, during the test occurs in 85.3% of subjects, but rarely (1.3%) leads to discontinuation. Headache (6.1%), pharyngolaryngeal pain (2.6%) and cough (1.3%) are the most frequent adverse events that occur on the day of the test...
Louisias, Margee; Phipatanakul, Wanda
In this article, we review current understanding of the epidemiology and etiology of disparities in asthma. We also highlight current and emerging literature on solutions to tackle disparities while underscoring gaps and pressing future directions. Tailored, multicomponent approaches including the home, school, and clinician-based interventions show great promise. Managing asthma in disadvantaged populations can be challenging as they tend to have disproportionately worse outcomes due to a multitude of factors. However, multifaceted, innovative interventions that are sustainable and scalable are key to improving outcomes.
Tinschert, Peter; Jakob, Robert; Barata, Filipe; Kramer, Jan-Niklas; Kowatsch, Tobias
Effective disease self-management lowers asthma's burden of disease for both individual patients and health care systems. In principle, mobile health (mHealth) apps could enable effective asthma self-management interventions that improve a patient's quality of life while simultaneously reducing the overall treatment costs for health care systems. However, prior reviews in this field have found that mHealth apps for asthma lack clinical evaluation and are often not based on medical guidelines. Yet, beyond the missing evidence for clinical efficacy, little is known about the potential apps might have for improving asthma self-management. The aim of this study was to assess the potential of publicly available and well-adopted mHealth apps for improving asthma self-management. The Apple App store and Google Play store were systematically searched for asthma apps. In total, 523 apps were identified, of which 38 apps matched the selection criteria to be included in the review. Four requirements of app potential were investigated: app functions, potential to change behavior (by means of a behavior change technique taxonomy), potential to promote app use (by means of a gamification components taxonomy), and app quality (by means of the Mobile Application Rating Scale [MARS]). The most commonly implemented functions in the 38 reviewed asthma apps were tracking (30/38, 79%) and information (26/38, 68%) functions, followed by assessment (20/38, 53%) and notification (18/38, 47%) functions. On average, the reviewed apps applied 7.12 of 26 available behavior change techniques (standard deviation [SD]=4.46) and 4.89 of 31 available gamification components (SD=4.21). Average app quality was acceptable (mean=3.17/5, SD=0.58), whereas subjective app quality lied between poor and acceptable (mean=2.65/5, SD=0.87). Additionally, the sum scores of all review frameworks were significantly correlated (lowest correlation: r 36 =.33, P=.04 between number of functions and gamification
Indinnimeo, Luciana; Chiappini, Elena; Miraglia Del Giudice, Michele
Acute asthma attack is a frequent condition in children. It is one of the most common reasons for emergency department (ED) visit and hospitalization. Appropriate care is fundamental, considering both the high prevalence of asthma in children, and its life-threatening risks. Italian Society of Pediatrics recently issued a guideline on the management of acute asthma attack in children over age 2, in ambulatory and emergency department settings. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was adopted. A literature search was performed using the Cochrane Library and Medline/PubMed databases, retrieving studies in English or Italian and including children over age 2 year. Inhaled ß 2 agonists are the first line drugs for acute asthma attack in children. Ipratropium bromide should be added in moderate/severe attacks. Early use of systemic steroids is associated with reduced risk of ED visits and hospitalization. High doses of inhaled steroids should not replace systemic steroids. Aminophylline use should be avoided in mild/moderate attacks. Weak evidence supports its use in life-threatening attacks. Epinephrine should not be used in the treatment of acute asthma for its lower cost / benefit ratio, compared to β 2 agonists. Intravenous magnesium solphate could be used in children with severe attacks and/or forced expiratory volume1 (FEV1) lower than 60% predicted, unresponsive to initial inhaled therapy. Heliox could be administered in life-threatening attacks. Leukotriene receptor antagonists are not recommended. This Guideline is expected to be a useful resource in managing acute asthma attacks in children over age 2.
Technical career opportunities in high-level radioactive waste management are briefly described in the areas of: Hydrology; geology; biological sciences; mathematics; engineering; heavy equipment operation; and skilled labor and crafts
Yamakage, Michiaki; Iwasaki, Sohshi; Namiki, Akiyoshi
Increased airway hyperresponsiveness is a major concern in the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease. Guidelines using evidence-based medicine are continually being updated and published regarding the diagnosis, treatment, and prevention of these respiratory disorders. Perioperative management in these patients involves: (1) adequate control of airway hyperresponsiveness, including detection of purulent sputum and infection before surgery; (2) evidence-based control of anesthesia; and (3) the aggressive use of beta-2 adrenergic stimulants and the systemic administration of steroids for the treatment of acute attacks. Good preoperative control, including the use of leukotriene antagonists, can reduce the incidence of life-threatening perioperative complications. Awareness of recent guidelines is thus important in the management of patients with airway hyperresponsiveness. This review covers the most recent guidelines for the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.
Aldini, Alessandro; Seigneur, Jean-Marc; Ballester Lafuente, Carlos; Titi, Xavier; Guislain, Jonathan
With the advent of the Bring-Your-Own-Device (BYOD) trend, mobile work is achieving a widespread diffusion that challenges the traditional view of security standard and risk management. A recently proposed model, called opportunity-enabled risk management (OPPRIM), aims at balancing the analysis of the major threats that arise in the BYOD setting with the analysis of the potential increased opportunities emerging in such an environment, by combining mechanisms of risk estimation with trust an...
Greenberg, Cindy; Luna, Pamela; Simmons, Gretchen; Huhman, Marian; Merkle, Sarah; Robin, Leah; Keener, Dana
Albuquerque Public Schools (APS), in collaboration with the Centers for Disease Control and Prevention, conducted an evaluation to examine whether students who were exposed to the APS asthma program in elementary school retained benefits into middle school. APS middle school students who participated in the APS asthma program in elementary school, including the Open Airways for Schools (OAS) education curriculum, responded to a follow-up questionnaire (N = 121) and participated in student focus groups (N = 40). Asthma management self-efficacy scores from the follow-up questionnaire were compared to scores obtained before and after the OAS education component. Additional items assessed students' asthma symptoms, management skills, avoidance of asthma triggers, and school impact. Although asthma management self-efficacy scores declined in middle school among students exposed to the asthma program in elementary school, they remained significantly higher than scores obtained during elementary school prior to the OAS intervention. The results indicate that although students benefited from the asthma program delivered in elementary school, they need booster sessions and continued school support in middle school.
Househ, Mowafa; Hossain, Nassif; Jamal, Amr; Zakaria, Nasriah; Elmetwally, Ashraf; Alsalamah, Majid; Khalifa, Mohamed
Providing patients opportunities for self-management and education about their disease, asthma applications designed for use on an Android operating system can have positive health outcomes across the range of demographics who use mHealth applications. This study provides a content analysis of freely available Google Android Platform Mobile Applications for Asthma. A list of applications was collected on 26 October 2014, using the search feature of the Google Play Android platform and using the words and phrases "Asthma," "Lung Function" and "Peak Flow." Each application was coded for its approach to asthma self-management, based on categories adapted by Huckvale et al., which are based on the Global Initiative for Asthma and the National Asthma Education and Prevention Program. The characteristics of the 15 asthma applications are described. Most of the asthma applications' primary function focused on patient self-monitoring and self-assessment. Using the HON Code, we found low health information quality across all asthma applications. Android asthma applications can have positive outcomes in helping patients as they provide opportunities for self-management and education about their disease. Future research should continue to monitor and evaluate the development and use of mHealth Asthma Applications. Based on these findings, and their indication of a gap in existing research, subsequent studies can continue to evaluate the development and use of mHealth Asthma Applications with increasing methodological consistency to improve the quality of in-app health information.
Neslin, Scott A.; Grewal, Dhruv; Leghorn, Robert; Shankar, Venkatesh; Teerling, Marije L.; Thomas, Jacquelyn S.; Verhoef, Peter C.
Multichannel customer management is the design, deployment, coordination, and evaluation of channels through which firms and customers interact, with the goal of enhancing customer value through effective customer acquisition, retention, and development. The authors identify five major challenges
Neslin, Scott A.; Grewal, Dhruv; Leghorn, Robert; Shankar, Venkatesh; Teerling, Marije L.; Thomas, Jacquelyn S.; Verhoef, Peter C.
Multichannel customer management is the design, deployment, coordination, and evaluation of channels through which firms and customers interact, with the goal of enhancing customer value through effective customer acquisition, retention, and development. The authors identify five major challenges
Full Text Available ... In the Workplace Outdoors Management Asthma Action Plan Flu Shots Inhalers Data, Statistics, and Surveillance Most Recent ... AsthmaStats Asthma as the Underlying Cause of Death Flu Vaccination among Adults with Current Asthma Flu Vaccination ...
Full Text Available Richelle C Kosse,1 Marcel L Bouvy,1 Tjalling W de Vries,2 Ad A Kaptein,3 Harm CJ Geers,1 Liset van Dijk,4 Ellen S Koster1 1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, 2Department of Paediatrics, Medical Center Leeuwarden, Leeuwarden, 3Medical Psychology, Leiden University Medical Center, Leiden, 4NIVEL, the Netherlands Institute for Health Services Research, Utrecht, the Netherlands Purpose: Poor medication adherence in adolescents with asthma results in poorly controlled disease and increased morbidity. The aim of the ADolescent Adherence Patient Tool (ADAPT study is to develop an mHealth intervention to support self-management and to evaluate the effectiveness in improving medication adherence and asthma control. Intervention: The ADAPT intervention consists of an interactive smartphone application (app connected to a desktop application for health care providers, in this study, the community pharmacist. The app contains several functions to improve adherence as follows: 1 a questionnaire function to rate asthma symptoms and monitor these over time; 2 short movie clips with medication and disease information; 3 a medication reminder; 4 a chat function with peers; and 5 a chat function with the pharmacist. The pharmacist receives data from the patient’s app through the desktop application, which enables the pharmacist to send information and feedback to the patient. Study design: The ADAPT intervention is tested in a community pharmacy-based cluster randomized controlled trial in the Netherlands, aiming to include 352 adolescents with asthma. The main outcome is adherence, measured by patient’s self-report and refill adherence calculated from pharmacy dispensing records. In addition, asthma control, illness perceptions, medication beliefs, and asthma-related quality of life are measured. Conclusion: This study will provide in
Kim, Soo Yun; Hong, Yangsun; Chih, Ming-Yuan; Shah, Dhavan V.; Gustafson, David H.
Abstract Background: With the increasing penetration of digital mobile devices among adolescents, mobile texting messaging is emerging as a new channel for patient–clinician communication for this population. In particular, it can promote active communication between healthcare clinicians and adolescents with asthma. However, little is known about the content of the messages exchanged in medical encounters via mobile text messaging. Therefore, this study explored the content of text messaging between clinicians and adolescents with asthma. Materials and Methods: We collected a total of 2,953 text messages exchanged between 5 nurse case managers and 131 adolescents with asthma through a personal digital assistant. The text messages were coded using a scheme developed by adapting categories from the Roter Interaction Analysis System. Results: Nurse case managers sent more text messages (n=2,639) than adolescents with asthma. Most messages sent by nurse case managers were targeted messages (n=2,475) directed at all adolescents with asthma, whereas there were relatively few tailored messages (n=164) that were created personally for an individual adolescent. In addition, both targeted and tailored messages emphasized task-focused behaviors over socioemotional behaviors. Likewise, text messages (n=314) sent by adolescents also emphasized task-focused over socioemotional behaviors. Conclusions: Mobile texting messaging has the potential to play an important role in patient–clinician communication. It promotes not only active interaction, but also patient-centered communication with clinicians. In order to achieve this potential, healthcare clinicians may need to focus on socioemotional communication as well as task-oriented communication. PMID:25401324
Hanna, Tamer; Bajorek, Beata; LeMay, Kate; Armour, Carol L.
Roberts, James R; Newman, Nicholas; McCurdy, Leyla E; Chang, Jane S; Salas, Mauro A; Eskridge, Bernard; De Ybarrondo, Lisa; Sandel, Megan; Mazur, Lynnette; Karr, Catherine J
The National Environmental Education Foundation (NEEF) launched an initiative in 2005 to integrate environmental management of asthma into pediatric health care. This study, a follow-up to a 2013 study, evaluated the program's impact and assessed training results by 5 new faculty champions. We surveyed attendees at training sessions to measure knowledge and the likelihood of asking about and managing environmental triggers of asthma. To conduct the program evaluation, a workshop was held with the faculty champions and NEEF staff in which we identified major program benefits, as well as challenges and suggestions for the future. Trainee baseline knowledge of environmental triggers was low, but they reported robust improvement in environmental triggers knowledge and intention to recommend environmental management. The program has a broad, national scope, reaching more than 12 000 physicians, health care providers, and students, and some faculty champions successfully integrated materials into health record. Program barriers and future endeavors were identified.
Shegog, Ross; Bartholomew, L Kay; Gold, Robert S; Pierrel, Elaine; Parcel, Guy S; Sockrider, Marianna M; Czyzewski, Danita I; Fernandez, Maria E; Berlin, Nina J; Abramson, Stuart
Translating behavioral theories, models, and strategies to guide the development and structure of computer-based health applications is well recognized, although a continued challenge for program developers. A stepped approach to translate behavioral theory in the design of simulations to teach chronic disease management to children is described. This includes the translation steps to: 1) define target behaviors and their determinants, 2) identify theoretical methods to optimize behavioral change, and 3) choose educational strategies to effectively apply these methods and combine these into a cohesive computer-based simulation for health education. Asthma is used to exemplify a chronic health management problem and a computer-based asthma management simulation (Watch, Discover, Think and Act) that has been evaluated and shown to effect asthma self-management in children is used to exemplify the application of theory to practice. Impact and outcome evaluation studies have indicated the effectiveness of these steps in providing increased rigor and accountability, suggesting their utility for educators and developers seeking to apply simulations to enhance self-management behaviors in patients.
Patel, Minal R.; Caldwell, Cleopatra H.; Id-Deen, Effat; Clark, Noreen M.
Objective Despite economic hardship, compliance with self-management regimens is still evident among individuals and families managing chronic disease. The purpose of this study was to describe how women with asthma address cost-related challenges to management of their condition. Methods In 2012 and 2013, four focus groups were conducted in Southeast Michigan with 26 African American women with asthma, recruited based on maximum variation sampling procedures. A semi-structured interview protocol was employed by trained facilitators. Coded transcripts were analyzed for themes regarding means to reduce the impact of the cost of asthma management. Results Major themes identified were acceptance of the status quo; stockpiling and sharing medicines; utilizing community assistance programs; reaching out to healthcare providers and social networks for help; foregoing self-management; and utilizing urgent care. Conclusions Awareness of strategies that are helpful to patients in reducing out-of-pocket costs may better equip service providers and others to develop interventions to make useful strategies more widely available. PMID:24471517
Full Text Available This review article seeks to answer the question of whether one can define a minimal and required set of criteria (dimensions, indicators to measure the quality of tourism services. The selected metrics should fulfil the expectations of all actors in the tourism industry, primarily the management, employees and tourists. The tourism industry brings up a variety of ideas for quality management, expressible through quantitative and qualitative indicators. There is often a dilemma of which set of indicators to choose. We have applied numerous different citations and quotations of theoretical and practical sources in the area of quality metrics. We come to realize that the focus of the concept of monitoring the quality of services in tourism shifts from the user of services to the employees. The answer lies in the fact that only a happy and successful worker in the tourism industry can provide an adequate service that tourists perceive as excellent.
applies to someone who has the physical, cultural, or linguistic characteristics of a national group. Personal Racism , Sexism , or Bigotry: The ...Management and Army Demographics and Statistics Departments. LTC Horrell arranged my VIP trip to the Defense Equal Opportunity Management Institute (DEOMI...harassment in the organization. Organizational productivity is maximized when illegal discrimination is eradicated. One theory of why discrimination
Friend, Mary; Morrison, Amber
Improvement of medication adherence in the school-age child can lead to improvement in quality of life, decreased morbidity, and a potential decreased risk of deferred academic, social, and emotional development. The objective of this article is to review barriers to asthma medication adherence and identify evidence-based techniques that improve medication management of the asthmatic child 5 to 12 years of age. A literature review was performed and articles were obtained through database searches within Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PubMed. Research indicates that barriers to the adherence of medication regimens required for asthmatic children include poor understanding of the medication regimen, substandard education on symptom recognition and environmental triggers, rejection of the diagnosis, and a lack of support or understanding within the community. Researched techniques aimed to improve medication management in 5- to 12-year-olds include: computer-based education; workshops for parents, teachers, and children; incorporation of asthma education into classroom lessons; use of case managers; the introduction of a nurse practitioner in the school to provide care, including medication prescriptions for the asthmatic child; and assessment and evaluation of environmental and emotional triggers in the home and school. Collaboration of current data may help lead to a successful interventional model that can improve asthma management in this population. © The Author(s) 2014.
Sokol, Kristin C; Sharma, Gulshan; Lin, Yu-Li; Goldblum, Randall M
The National Asthma Education and Prevention Program (NAEPP) and the American Thoracic Society provide guidelines stating that physicians should use spirometry in the diagnosis and management of asthma. The aim of this study was to evaluate the trends, over a 10-year period, in the utilization of spirometry in patients newly diagnosed with asthma. We hypothesized that spirometry use would increase in physicians who care for asthma patients, especially since 2007, when the revised NAEPP guidelines were published. This retrospective cohort analysis of spirometry use in subjects newly diagnosed with asthma used a privately insured adult population for the years 2002-2011. Our primary outcome of interest was spirometry performed within a year (± 365 days) of the initial date of asthma diagnosis. We also examined the type of asthma medications prescribed. In all, 134,208 patients were found to have a diagnosis of asthma. Only 47.6% had spirometry performed within 1 year of diagnosis. Younger patients, males, and those residing in the Northeast were more likely to receive spirometry. Spirometry use began to decline in 2007. Patients cared for by specialists were more likely to receive spirometry than those cared for by primary care physicians; 80.1% vs 23.3%, respectively. Lastly, even without spirometry, a significant portion of patients (78.3%) was prescribed asthma drugs. Our study suggests that spirometry is underutilized in newly diagnosed asthma patients. Moreover, the use of controller medications in those diagnosed with asthma without spirometry remains high. Copyright © 2015 Elsevier Inc. All rights reserved.
van Gaalen, J.L.; Bakker, M.J.; Bodegom-Vos, L. van; Snoeck-Stroband, J.B.; Assendelft, W.J.J.; Kaptein, A.A.; van der Meer, V.; Taube, C.; Thoonen, B.P.A.; Sont, J.K.; for the, I.s.g.
ABSTRACT: BACKGROUND: Internet-based self-management (IBSM) support cost-effectively improves asthma control, asthma related quality of life, number of symptom-free days, and lung function in patients with mild to moderate persistent asthma. The current challenge is to implement IBSM in clinical
Gil, David; Song, Il-Yeol
The term Big Data denotes huge-volume, complex, rapid growing datasets with numerous, autonomous and independent sources. In these new circumstances Big Data bring many attractive opportunities; however, good opportunities are always followed by challenges, such as modelling, new paradigms, novel architectures that require original approaches to address data complexities. The purpose of this special issue on Modeling and Management of Big Data is to discuss research and experience in modellin...
Elaro, Amanda; Bosnic-Anticevich, Sinthia; Kraus, Kathleen; Farris, Karen B; Shah, Smita; Armour, Carol; Patel, Minal R
Objective To explore community pharmacists' continuing education, counseling and communication practices, attitudes and barriers in relation to pediatric asthma management. Setting Community pharmacies in Michigan, United States. Methods Between July and September 2015 a convenience sample of community pharmacists was recruited from southeastern Michigan and asked to complete a structured, self-reported questionnaire. The questionnaire elucidated information on 4 general domains relating to pharmacists' pediatric asthma management including: (1) guidelines and continuing education (CE); (2) counseling and medicines; (3) communication and self-management practices; (4) attitudes and barriers to practice. Regression analyses were conducted to determine predictors towards pharmacists' confidence/frequency of use of communication/counseling strategies. Main outcome measure Confidence in counseling skills around asthma. Results 105 pharmacists completed the study questionnaire. Fifty-four percent of pharmacists reported participating in asthma related CE in the past year. Over 70% of pharmacists reported confidence in general communication skills, while a lower portion reported confidence in engaging in higher order self-management activities that involved tailoring the regimen (58%), decision-making (50%) and setting short-term (47%) and long-term goals (47%) with the patient and caregiver for managing asthma at home. Pharmacists who reported greater use of recommended communication/self-management strategies were more likely to report confidence in implementing these communication/self-management strategies when counseling caregivers and children with asthma [Beta (B) Estimate 0.58 SE (0.08), p management strategies. Conclusion A pharmacists' confidence may influence their ability to implement recommended self-management counseling strategies. This study showed that community pharmacists are confident in general communication. However pharmacists are reporting lower
Prins, L.C.; van Son, M.J.M.; Keimpema, A.R.; van Ranst, D; Pommer, A; Meijer, J.W.; Pop, V.J.M.
OBJECTIVE: Within the asthma population, difficult asthma (DA) is a severe condition in which patients present with frequent exacerbations, hospitalizations and emergency room visits. The identification and treatment of psychopathology is included in the management of DA. Psychopathology is supposed
Mehring, Michael; Donnachie, Ewan; Mutschler, Robert; Hofmann, Frank; Keller, Manfred; Schneider, Antonius
The primary aim of the disease management program (DMP) for patients with asthma is to improve health outcomes and to reduce costs. Five years after its introduction in Germany, no consensus has yet been reached as to whether DMP has been effective in reaching these goals. To evaluate the DMP for asthma in Bavaria using routinely collected subject medical records. A longitudinal population-based study encompassing over 100,000 DMP participants between 2006 (when the program began) and 2010. The prescription rate of oral corticosteroids dropped from 15.7% in 2006 to 13.6% in 2007, and again from 7.5% in 2008 to 5.9% in 2010 (P management education increased from 4.4% to 23.4% (P management. The proportion of subjects requiring hospitalization decreased. Our results suggest that the German DMP for asthma has been effective in enhancing the quality of care in regard to an improved symptom frequency, adherence to guidelines, pharmacotherapy, and hospitalization.
Robijn, Annelies L; Jensen, Megan E; Gibson, Peter G; Powell, Heather; Giles, Warwick B; Clifton, Vicki L; Mattes, Joerg; Peek, Michael J; Barrett, Helen L; Seeho, Sean K; Callaway, Leonie K; Abbott, Alistair; Attia, John; Wark, Peter A; Murphy, Vanessa E
Asthma exacerbations and medication non-adherence are significant clinical problems during pregnancy. While asthma self-management education is effective, the number of education sessions required to maximise asthma management knowledge and inhaler technique and whether improvements persist postpartum, are unknown. This paper describes how asthma knowledge, skills, and inhaled corticosteroid (ICS) use have changed over time. Data were obtained from 3 cohorts of pregnant women with asthma recruited in Newcastle, Australia between 2004 and 2017 (N = 895). Medication use, adherence, knowledge, and inhaler technique were compared between cohorts. Changes in self-management knowledge/skills and women's perception of medication risk to the fetus were assessed in 685 women with 5 assessments during pregnancy, and 95 women who had a postpartum assessment. At study entry, 41%, 29%, and 38% of participants used ICS in the 2004, 2007, and 2013 cohorts, respectively (p = 0.017), with 40% non-adherence in each cohort. Self-management skills of pregnant women with asthma did not improve between 2004 and 2017 and possession of a written action plan remained low. Maximum improvements were reached by 3 sessions for medications knowledge and one session for inhaler technique, and were maintained postpartum. ICS adherence was maximally improved after one session, but not maintained postpartum. Perceived risk of asthma medications on the fetus was highest for corticosteroid-containing medication; and was significantly reduced following education. There was a high prevalence of non-adherence and poor self-management skills in all cohorts. More awareness of the importance of optimal asthma management during pregnancy is warranted, since no improvements were observed over the past decade.
Mgaloblishvili, N; Gotua, M
Asthma is a pathologically heterogeneous disease, consisting of several phenotypes. Different types of airway inflammation are the cornerstone feature of this condition. Fraction of nitric oxide in exhaled air (FENO) has been proposed as a noninvasive, specific biomarker for eosinophilic airway inflammation and has been shown to be elevated in patients with allergic asthma phenotype. More recent studies indicate that FeNO identifies T-helper cell type 2 (Th2)-mediated airway inflammation with a high predictive value for identifying inhaled corticosteroid (ICS) responsive airway inflammation. Taking into account the accumulated evidence,it is possible to consider, that FeNO testing has an important role in the assessment of patients with suspected asthma and in the management of established asthmadiagnosis. In conjunction with symptom scores and lung function tests, FeNO measurement could provide a more useful and effective approach for asthma in terms of: (1) detecting the presence of Th2-mediated airway inflammation, (2) determining the likelihood of ICS responsive (and lack of course), (3) monitoring of airway inflammation to determine risk for future impairment or loss of asthma control during reduction/cessation of ICS treatment, (4) unmasking (otherwise unsuspected) non-adherence to corticosteroid therapy and (5) in severe asthma cases tailoring treatment with biological drugs. However, more work is still needed to address outstanding questions about its exact role in guiding asthma management and better define the use of FENO in different clinical settings.
Patil, Dhiraj; Dash, Ranjeet Prasad; Thakur, Sandeep Kumar; Pandya, Amit N; Venkatesh, P; Vasu, Kamala K; Nivsarkar, Manish
Asthma is multifaceted disease where many targets contribute towards its development and progression. Among these, adenosine receptor subtypes play a major role. MCD-KV-10, a novel thiazolo-thiophene was designed and evaluated pre-clinically for its implication in management of asthma. This compound showed good affinity and selectivity towards A(2A)/A3 adenosine receptor (AR) subtypes. Furthermore, MCD-KV-10 was evaluated for in vitro lipoxygenase inhibition activity; in vivo mast cell stabilization potential and in vivo anti-asthmatic activity was done in ovalbumin-induced airway inflammation model in guinea pigs. The compound showed good (>57%) inhibition of lipoxygenase enzyme and also effectively protected mast cell degranulation (>63%). The compound showed good anti-asthmatic activity as inferred from the in vivo studies. These results indicate that MCD-KV-10 has an inhibitory effect on airway inflammation. Though, we have identified a potential candidate for management of asthma, further mechanistic studies are needed.
Mendling, Jan; Weber, Ingo; van der Aalst, Wil; Brocke, Jan vom; Cabanillas, Cristina; Daniel, Florian; Debois, Soren; Di Ciccio, Claudio; Dumas, Marlon; Dustdar, Schahram; Gal, Avigdor; Garcia-Banuelos, Luciano; Governatori, Guido; Hull, Richard; La Rosa, Marcello
Blockchain technology offers a sizable promise to rethink the way inter-organizational business processes are managed because of its potential to realize execution without a central party serving as a single point of trust (and failure). To stimulate research on this promise and the limits thereof, in this paper we outline the challenges and opportunities of blockchain for Business Process Management (BPM). We first reflect how blockchains could be used in the context of the established BPM l...
This paper sets out to start changing the perception that liabilities management is an unattractive part of the UK Nuclear Industry. The paper describes BNFL's successes and long term challenges in this area and concludes that liabilities management presents a major opportunity to:-Remove an Achilles heel of the industry; Create value for the companies concerned by successfully driving down costs; Sustain and exploit internationally a major UK competitive edge. (Author)
Application Opportunities of Agile Methodology in Service Company Management. The main purpose of this master thesis is to identify which methods (or their modified versions) of Agile methodology can be applied in service company management. This master thesis consists of these parts – literature scientific analysis, author’s research methodology (research methods, authors’ research model, essential elements used in the research of application of Agile methodology), research itself (prelimina...
W. Brad Smith; Tom D. Wardle
Reviews opportunities for treatment of timber stands in Nebraska for the decade 1983 - 1992. Under the assumptions and management guides specified, 52 percent of Nebraska''s commercial forest land would benefit from timber harvest or some other form of treatment during the decade.
Hite, Linda M.
This study explores the differing views of Black and White female managers regarding access to key career opportunities for White women and women of color. Items addressed include access to hiring, promotions, key assignments, salary increases, acknowledgment for work, and mentors. Access to each is described by comparing White women and women of…
Full Text Available offer a new opportunity for communities living within these catchments to share their knowledge and to become involved in planning and implementing the management process. This paper discusses the use of Participatory Rural Appraisal (PRA) in a catchment...
In 2003 Tanzania established 16 pilot Wildlife Management Areas (WMAs), with the aim of enhancing conservation and poverty alleviation through sustainable utilization of natural resources. This study examines the opportunities and challenges of this policy initiative with reference to the proposed WMAs. Data were ...
Halterman, Jill S; Fagnano, Maria; Tajon, Reynaldo S; Tremblay, Paul; Wang, Hongyue; Butz, Arlene; Perry, Tamara T; McConnochie, Kenneth M
Poor adherence to recommended preventive asthma medications is common, leading to preventable morbidity. We developed the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) program to build on school-based supervised therapy programs by incorporating telemedicine at school to overcome barriers to preventive asthma care. To evaluate the effect of the SB-TEAM program on asthma morbidity among urban children with persistent asthma. In this randomized clinical trial, children with persistent asthma aged 3 to 10 years in the Rochester City School District in Rochester, New York, were stratified by preventive medication use at baseline and randomly assigned to the SB-TEAM program or enhanced usual care for 1 school year. Participants were enrolled at the beginning of the school year (2012-2016), and outcomes were assessed through the end of the school year. Data were analyzed between May 2017 and November 2017 using multivariable modified intention-to-treat analyses. Supervised administration of preventive asthma medication at school as well as 3 school-based telemedicine visits to ensure appropriate assessment, preventive medication prescription, and follow-up care. The school site component of the telemedicine visit was completed by telemedicine assistants, who obtained history and examination data. These data were stored in a secure virtual waiting room and then viewed by the primary care clinician, who completed the assessment and communicated with caregivers via videoconference or telephone. Preventive medication prescriptions were sent to pharmacies that deliver to schools for supervised daily administration. The primary outcome was the mean number of symptom-free days per 2 weeks, assessed by bimonthly blinded interviews. Of the 400 enrolled children, 247 (61.8%) were male and 230 (57.5%) were African American, and the mean (SD) age was 7.8 (1.7) years. Demographic characteristics and asthma severity in the 2 groups were similar at baseline. Among
Full Text Available Ensuring equal opportunities is a priority for CEO-s and decision makers, however, it is often not put into practice. Changes in recent years along with the priorities of the EU and the efforts made to banish discrimination becoming more prominent brought with themselves a pressure on firms to provide equal opportunities for the different under-privileged social groups. In Hungary the Act CXXV of 2003 on discrimination and equal opportunities lists the groups in need of protection. The law requires employers with more than fifty employees to have an equal opportunities program. In spite of this, these programs are often general and do not implement the changes and goals identified after the assessment. Still, strategies and plans are only worth how much of them are realized. Our article is about the conscious principles of the Hungarian business sector about equality and whether there are regional differences. We compare answers given by both employers and employees on the subject of the extent to which the above mentioned principles are realized by the management and whether the employees experience these changes. Our theory is that the prioritisation of equal opportunities in firms is more the result of access to project funds than that of inner initiative from the firm's management. We analyse our research questions using a quantitative method on a regionally representative national sample. We examined 992 firms with special attention on those and their employees who had some sort of written guidelines on equal opportunities and plans on implementing these. In our paper we give a short review on the importance of equal opportunities, it's manifestation in HR management and it's written declaration, the so called Equal Opportunities Plan (EOP. The efforts of the EU and access to financial resources for the EU projects as a condition our hypotheses are that (1 at least 30% of the firms studied have written guidelines or declaration on equal
Rodriguez, Eunice; Rivera, Diana Austria; Perlroth, Daniella; Becker, Edmund; Wang, Nancy Ewen; Landau, Melinda
With increasing budget cuts to education and social services, rigorous evaluation needs to document school nurses' impact on student health, academic outcomes, and district funding. Utilizing a quasi-experimental design, we evaluated outcomes in 4 schools with added full-time nurses and 5 matched schools with part-time nurses in the San Jose Unified School District. Student data and logistic regression models were used to examine predictors of illness-related absenteeism for 2006-2007 and 2008-2009. We calculated average daily attendance (ADA) funding and parent wages associated with an improvement in illness-related absenteeism. Utilizing parent surveys, we also estimated the cost of services for asthma-related visits to the emergency room (ER; N = 2489). Children with asthma were more likely to be absent due to illness; however, mean absenteeism due to illness decreased when full-time nurses were added to demonstration schools but increased in comparison schools during 2008-2009, resulting in a potential savings of $48,518.62 in ADA funding (N = 6081). Parents in demonstration schools reported fewer ER visits, and the estimated savings in ER services and parent wages were significant. Full-time school nurses play an important role in improving asthma management among students in underserved schools, which can impact school absenteeism and attendance-related economic costs. © 2013, American School Health Association.
Slader, C A; Reddel, H K; Spencer, L M; Belousova, E G; Armour, C L; Bosnic-Anticevich, S Z; Thien, F C K; Jenkins, C R
Previous studies have shown that breathing techniques reduce short acting beta(2) agonist use and improve quality of life (QoL) in asthma. The primary aim of this double blind study was to compare the effects of breathing exercises focusing on shallow nasal breathing with those of non-specific upper body exercises on asthma symptoms, QoL, other measures of disease control, and inhaled corticosteroid (ICS) dose. This study also assessed the effect of peak flow monitoring on outcomes in patients using breathing techniques. After a 2 week run in period, 57 subjects were randomised to one of two breathing techniques learned from instructional videos. During the following 30 weeks subjects practised their exercises twice daily and as needed for relief of symptoms. After week 16, two successive ICS downtitration steps were attempted. The primary outcome variables were QoL score and daily symptom score at week 12. Overall there were no clinically important differences between the groups in primary or secondary outcomes at weeks 12 or 28. The QoL score remained unchanged (0.7 at baseline v 0.5 at week 28, p = 0.11 both groups combined), as did lung function and airway responsiveness. However, across both groups, reliever use decreased by 86% (p0.10 between groups). Peak flow monitoring did not have a detrimental effect on asthma outcomes. Breathing techniques may be useful in the management of patients with mild asthma symptoms who use a reliever frequently, but there is no evidence to favour shallow nasal breathing over non-specific upper body exercises.
Slader, C A; Reddel, H K; Spencer, L M; Belousova, E G; Armour, C L; Bosnic‐Anticevich, S Z; Thien, F C K; Jenkins, C R
Background Previous studies have shown that breathing techniques reduce short acting β2 agonist use and improve quality of life (QoL) in asthma. The primary aim of this double blind study was to compare the effects of breathing exercises focusing on shallow nasal breathing with those of non‐specific upper body exercises on asthma symptoms, QoL, other measures of disease control, and inhaled corticosteroid (ICS) dose. This study also assessed the effect of peak flow monitoring on outcomes in patients using breathing techniques. Methods After a 2 week run in period, 57 subjects were randomised to one of two breathing techniques learned from instructional videos. During the following 30 weeks subjects practised their exercises twice daily and as needed for relief of symptoms. After week 16, two successive ICS downtitration steps were attempted. The primary outcome variables were QoL score and daily symptom score at week 12. Results Overall there were no clinically important differences between the groups in primary or secondary outcomes at weeks 12 or 28. The QoL score remained unchanged (0.7 at baseline v 0.5 at week 28, p = 0.11 both groups combined), as did lung function and airway responsiveness. However, across both groups, reliever use decreased by 86% (p0.10 between groups). Peak flow monitoring did not have a detrimental effect on asthma outcomes. Conclusion Breathing techniques may be useful in the management of patients with mild asthma symptoms who use a reliever frequently, but there is no evidence to favour shallow nasal breathing over non‐specific upper body exercises. PMID:16517572
Alicea-Alvarez, Norma; Swanson-Biearman, Brenda; Kelsen, Steven G
Among the Hispanic community, Puerto Ricans have the highest prevalence of asthma and manifest the worst outcomes. The expected growth of the Hispanic population in the USA in the next several decades make elimination of disparate care in Puerto Rican asthmatics a matter of national importance. The purpose of this review of the literature (ROL) is to examine a variety of health system, genetic and cultural barriers in the Puerto Rican community which have created disparities in asthma care and outcomes among adult and pediatric Hispanic populations. In addition, this ROL describes several culturally sensitive, community-based educational interventions which can be used as a framework for future projects to improved asthma outcomes. Databases searched included Medline, PubMED, EBSCOhost, PsycINFO, CINAHL, Google Scholar and ERIC. Papers published in English from January 1990 to January 2012 were reviewed. Health system policies, insurer compensation patterns, clinician attitudes and cultural values/folk remedies in the Puerto Rican community represent barriers to effective asthma management, the use of controller medication and the implementation of educational interventions. In addition, genetic factors involving the beta-2 adrenergic receptor gene, which impair the response to albuterol, appear to contribute to poorer outcomes in Puerto Rican asthmatics. In contrast, several comprehensive, community-based, culturally sensitive educational interventions such as Controlling Asthma in American Cities Project (CAACP), the Racial and Ethnic Approach to Community Health in the US Program and Healthy Hoops programs (REACH) have been described. We believe that culturally sensitive community-based asthma education programs can serve as models for programs targeted toward Puerto Ricans to help decrease asthma morbidity. Moreover, greater sensitivity to Puerto Rican mores and folk remedies on the part of healthcare providers may improve the patient-clinician rapport and
This paper aims toreexamine strategic management accouning in relation to profit opportunity and risk from the viewpoint of feed-forward management , as few studies to date have discuued the relations between management accounting and the unified management of profit opportunity and risk.Many studies have been conducted that emphasize non-fine information and feedback organizational management in an attept to make traditional management accounting relevant to practical strategic needs. As lon...
Drummond, David; Truchot, Jennifer; Fabbro, Eleonora; Ceccaldi, Pierre-François; Plaisance, Patrick; Tesnière, Antoine; Hadchouel, Alice
Simulation-based trainings represent an interesting approach to teach medical students the management of pediatric asthma exacerbations (PAEs). In this study, we compared two pedagogical approaches, training students once on three different scenarios of PAEs versus training students three times on the same scenario of PAE. Eighty-five third-year medical students, novice learners for the management of PAEs, were randomized and trained. Students were assessed twice, 1 week and 4 months after the training, on a scenario of PAE new to both groups and on scenarios used during the training. The main outcome was the performance score on the new scenario of PAE at 1 week, assessed on a checklist custom-designed for the study. All students progressed rapidly and acquired excellent skills. One week after the training, there was no difference between the two groups on all the scenarios tested, including the new scenario of PAE (median performance score (IQR) of 8.3 (7.4-10.0) in the variation group versus 8.0 (6.0-10.0) in the repetition group (p = 0.16)). Four months later, the performance of the two groups remained similar. Varying practice with different scenarios was equivalent to repetitive practice on the same scenario for novice learners, with both methods leading to transfer and long-term retention of the skills acquired during the training. What is known: • Simulation-based trainings represent an interesting approach to teach medical students the management of pediatric asthma exacerbations. • It is unclear whether students would benefit more from repetitive practice on the same scenario of asthma exacerbation or from practice on different scenarios in terms of transfer of skills. What is new: • An individual 30-min training on the management of pediatric asthma exacerbations using simulation allows transfer and long-term retention of the skills acquired. • Varying practice with different scenarios is equivalent to repetitive practice on the same
... Educators Search English Español What's an Asthma Action Plan? KidsHealth / For Parents / What's an Asthma Action Plan? ... acción contra el asma? What's an Asthma Action Plan? An asthma action plan (or management plan) is ...
Morrison, Deborah; Wyke, Sally; Thomson, Neil C; McConnachie, Alex; Agur, Karolina; Saunderson, Kathryn; Chaudhuri, Rekha; Mair, Frances S
The financial costs associated with asthma care continue to increase while care remains suboptimal. Promoting optimal self-management, including the use of asthma action plans, along with regular health professional review has been shown to be an effective strategy and is recommended in asthma guidelines internationally. Despite evidence of benefit, guided self-management remains underused, however the potential for online resources to promote self-management behaviors is gaining increasing recognition. The aim of this paper is to describe the protocol for a pilot evaluation of a website 'Living well with asthma' which has been developed with the aim of promoting self-management behaviors shown to improve outcomes. The study is a parallel randomized controlled trial, where adults with asthma are randomly assigned to either access to the website for 12 weeks, or usual asthma care for 12 weeks (followed by access to the website if desired). Individuals are included if they are over 16-years-old, have a diagnosis of asthma with an Asthma Control Questionnaire (ACQ) score of greater than, or equal to 1, and have access to the internet. Primary outcomes for this evaluation include recruitment and retention rates, changes at 12 weeks from baseline for both ACQ and Asthma Quality of Life Questionnaire (AQLQ) scores, and quantitative data describing website usage (number of times logged on, length of time logged on, number of times individual pages looked at, and for how long). Secondary outcomes include clinical outcomes (medication use, health services use, lung function) and patient reported outcomes (including adherence, patient activation measures, and health status). Piloting of complex interventions is considered best practice and will maximise the potential of any future large-scale randomized controlled trial to successfully recruit and be able to report on necessary outcomes. Here we will provide results across a range of outcomes which will provide estimates of
Bellazzi, Riccardo; Dagliati, Arianna; Sacchi, Lucia; Segagni, Daniele
The so-called big data revolution provides substantial opportunities to diabetes management. At least 3 important directions are currently of great interest. First, the integration of different sources of information, from primary and secondary care to administrative information, may allow depicting a novel view of patient’s care processes and of single patient’s behaviors, taking into account the multifaceted nature of chronic care. Second, the availability of novel diabetes technologies, ab...
Essat, Munira; Harnan, Sue; Gomersall, Tim; Tappenden, Paul; Wong, Ruth; Pavord, Ian; Lawson, Rod; Everard, Mark L
The aim of this review was to evaluate the clinical effectiveness of fractional exhaled nitric oxide (FeNO) measured in a clinical setting for the management of asthma in adults.13 electronic databases were searched and studies were selected against predefined inclusion criteria. Quality assessment was conducted using QUADAS-2. Class effect meta-analyses were performed.Six studies were included. Despite high levels of heterogeneity in multiple study characteristics, exploratory class effect meta-analyses were conducted. Four studies reported a wider definition of exacerbation rates (major or severe exacerbation) with a pooled rate ratio of 0.80 (95% CI 0.63-1.02). Two studies reported rates of severe exacerbations (requiring oral corticosteroid use) with a pooled rate ratio of 0.89 (95% CI 0.43-1.72). Inhaled corticosteroid use was reported by four studies, with a pooled standardised mean difference of -0.24 (95% CI -0.56-0.07). No statistically significant differences for health-related quality of life or asthma control were found.FeNO guided management showed no statistically significant benefit in terms of severe exacerbations or inhaled corticosteroid use, but showed a statistically significant reduction in exacerbations of any severity. However, further research is warranted to clearly define which management protocols (including cut-off points) offer best efficacy and which patient groups would benefit the most. Copyright ©ERS 2016.
Kumar, Sunil; Smith, Stephen R.; Fowler, Geoff; Velis, Costas; Kumar, S. Jyoti; Arya, Shashi; Rena; Kumar, Rakesh
India faces major environmental challenges associated with waste generation and inadequate waste collection, transport, treatment and disposal. Current systems in India cannot cope with the volumes of waste generated by an increasing urban population, and this impacts on the environment and public health. The challenges and barriers are significant, but so are the opportunities. This paper reports on an international seminar on ‘Sustainable solid waste management for cities: opportunities in South Asian Association for Regional Cooperation (SAARC) countries’ organized by the Council of Scientific and Industrial Research-National Environmental Engineering Research Institute and the Royal Society. A priority is to move from reliance on waste dumps that offer no environmental protection, to waste management systems that retain useful resources within the economy. Waste segregation at source and use of specialized waste processing facilities to separate recyclable materials has a key role. Disposal of residual waste after extraction of material resources needs engineered landfill sites and/or investment in waste-to-energy facilities. The potential for energy generation from landfill via methane extraction or thermal treatment is a major opportunity, but a key barrier is the shortage of qualified engineers and environmental professionals with the experience to deliver improved waste management systems in India. PMID:28405362
Kumar, Sunil; Smith, Stephen R; Fowler, Geoff; Velis, Costas; Kumar, S Jyoti; Arya, Shashi; Rena; Kumar, Rakesh; Cheeseman, Christopher
India faces major environmental challenges associated with waste generation and inadequate waste collection, transport, treatment and disposal. Current systems in India cannot cope with the volumes of waste generated by an increasing urban population, and this impacts on the environment and public health. The challenges and barriers are significant, but so are the opportunities. This paper reports on an international seminar on 'Sustainable solid waste management for cities: opportunities in South Asian Association for Regional Cooperation (SAARC) countries' organized by the Council of Scientific and Industrial Research-National Environmental Engineering Research Institute and the Royal Society. A priority is to move from reliance on waste dumps that offer no environmental protection, to waste management systems that retain useful resources within the economy. Waste segregation at source and use of specialized waste processing facilities to separate recyclable materials has a key role. Disposal of residual waste after extraction of material resources needs engineered landfill sites and/or investment in waste-to-energy facilities. The potential for energy generation from landfill via methane extraction or thermal treatment is a major opportunity, but a key barrier is the shortage of qualified engineers and environmental professionals with the experience to deliver improved waste management systems in India.
Mendling, Jan; Weber, Ingo; Van Der Aalst, Wil
Blockchain technology offers a sizable promise to rethink the way inter-organizational business processes are managed because of its potential to realize execution without a central party serving as a single point of trust (and failure). To stimulate research on this promise and the limits thereof......, in this paper we outline the challenges and opportunities of blockchain for Business Process Management (BPM). We first reflect how blockchains could be used in the context of the established BPM lifecycle and second how they might become relevant beyond. We conclude our discourse with a summary of seven...... research directions for investigating the application of blockchain technology in the context of BPM...
Schüz, Benjamin; Walters, Julia; Walters, E Haydn
Background Mobile technology interventions (MTI) are becoming increasingly popular in the management of chronic health behaviors. Most MTI allow individuals to monitor medication use, record symptoms, or store and activate disease-management action plans. Therefore, MTI may have the potential to improve low adherence to medication and action plans for individuals with asthma, which is associated with poor clinical outcomes. Objective A systematic review and meta-analysis were conducted to evaluate the efficacy of MTI on clinical outcomes as well as adherence in individuals with asthma. As the use of evidence-based behavior change techniques (BCT) has been shown to improve intervention effects, we also conducted exploratory analyses to determine the role of BCT and engagement with MTI as moderators of MTI efficacy. Methods We searched electronic databases for randomized controlled trials up until June 2016. Random effect models were used to assess the effect of MTI on clinical outcomes as well as adherence to preventer medication or symptom monitoring. Mixed effects models assessed whether the features of the MTI (ie, use of BCT) and how often a person engaged with MTI moderated the effects of MTI. Results The literature search located 11 studies meeting the inclusion criteria, with 9 providing satisfactory data for meta-analysis. Compared with standard treatment, MTI had moderate to large effect sizes (Hedges g) on medication adherence and clinical outcomes. MTI had no additional effects on adherence or clinical outcomes when compared with paper-based monitoring. No moderator effects were found, and the number of studies was small. A narrative review of the two studies, which are not included in the meta-analysis, found similar results. Conclusions This review indicated the efficacy of MTI for self-management in individuals with asthma and also indicated that MTI appears to be as efficacious as paper-based monitoring. This review also suggested a need for robust
According to a study done in 2014 by National Health Interview Survey around 6.3 million children in United States suffer from asthma . Asthma remains one of the leading reasons for pediatric admissions to children's hospitals, and has a prevalence rate of approximately 10% in children and it leads to missed days from school and other societal costs. This occurs despite improved medications to control asthma symptoms. Asthma management is challenging as it involves understanding asthma causes and avoiding asthma triggers that are both multi-factorial and individualistic in nature. It is almost impossible for doctors to constantly monitor each patient's health and environmental triggers. According to a recent article, the IoT device market in health-care will increase to a worth of $117 billion by the year 2020 . The monitoring segment of IoT devices have predicted to increase $15 billion in 2017 . The sales of smart watches, fitness and health trackers, are expected to account for more than 70% of all wearables sale worldwide in 2016 . According to IBM, the volume of health-care data has reached to 150 exabytes in 2017 . The data generated from these consumer graded devices is increasing day by day. This data collection has exacerbated the problem of understanding the data and making sense of it.
The management team of the future will enter an environment requiring facilitation, participation, clinical, and empowerment skills. Those individuals who possess a clinical orientation as well as business expertise will be sought to manage multidisciplinary units. The rapid changes in the health-care environment have forced organizations to restructure their operations. To achieve quality care, customer satisfaction, cost-effectiveness, and efficiency, service integration across the organization will be required. As we approach the 21st century, this standard will evolve until "all levels are managing patient care." Some of the restructuring trends occurring in the health-care industry have been collaboration service integration, management consolidation, and job elimination. The emphasis for the multidisciplinary manager of the future will include integrating the professional and clinical services, managing information, building community partnerships, promoting physician collaboration, and managing the change process. A model organization in the next century will move toward a people-oriented system with inclusion and empowerment initiatives. Service integration will affect all organizations, but the disciplines within the Clinical Support System will be the most affected. Future opportunities of leadership will exist for pathologists, nurses, or medical technologists as the professional silos of managers and clinicians continue to crumble.
... BS, Burks AW, et al, eds. Middleton's Allergy Principles and Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 53. Lugogo N, Que LG, Gilstrap DL, Kraft M. Asthma: clinical diagnosis and management. In: Broaddus VC, Mason RJ, Ernst JD, et ...
Steppuhn, Henriette; Langen, Ute; Mueters, Stephan; Dahm, Stefan; Knopf, Hildtraud; Keil, Thomas; Scheidt-Nave, Christa
In Germany, population-wide data on adherence to national asthma management guidelines are lacking, and performance measures (PM) for quality assurance in asthma care are systematically monitored for patients with German national asthma disease management program (DMP) enrollment only. We used national health survey data to assess variation in asthma care PM with respect to patient characteristics and care context, including DMP enrollment. Among adults 18-79 years with self-reported physician-diagnosed asthma in the past 12 months identified from a recent German National Health Interview Survey (GEDA 2010: N = 1096) and the German National Health interview and Examination Survey 2008-2011 (DEGS1: N = 333), variation in asthma care PM was analyzed using logistic regression analysis. Overall, 38.4% (95% confidence interval: 32.5-44.6%) of adults with asthma were on current inhaled corticosteroid therapy. Regarding non-drug asthma management, low coverage was observed for inhaler technique monitoring (35.2%; 31.2-39.3%) and for provision of an asthma management plan (27.3%; 24.2-30.7%), particularly among those with low education. Specific PM were more complete among persons with than without asthma DMP enrollment (adjusted odds ratios ranging up to 10.19; 5.23-19.86), even if asthma patients were regularly followed in a different care context. Guideline adherence appears to be suboptimal, particularly with respect to PM related to patient counseling. Barriers to the translation of recommendations into practice need to be identified and continuous monitoring of asthma care PM at the population level needs to be established.
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... reasons to celebrate its journals. Learn More about the American Academy Of Allergy, Asthma & Immunology Life Spectrum of Asthma Meeting School-based Asthma Management Program – (SAMPRO TM ) This central resource focuses on ...
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de Groot, Jantina C.; ten Brinke, Anneke; Bel, Elisabeth H. D.
Now that it is generally accepted that asthma is a heterogeneous condition, phenotyping of asthma patients has become a mandatory part of the diagnostic workup of all patients who do not respond satisfactorily to standard therapy with inhaled corticosteroids. Late-onset eosinophilic asthma is
Nordin, R. Mohd; Latip, E.; Zawawi, E. M. Ahmad; Ismail, Z.
Flood is one of the major disasters in the world. Despite flood resulted in loss of life and damaged properties, it naturally imparts people to assist the victims that affected by the disaster. Malaysia has experienced many serious flooding events and proper flood disaster management need to be developed and adopted occasionally. Flood Disaster Management (FDM) seemed to be not working effectively especially during the Kelantan prodigious flood in December 2014. There were negative perceptions among victims and Malaysian citizens regarding the disaster management and government authorities in relation to corrupt practices. The FDM can be divided into four phases (i.e., prevention, preparedness, response and recovery) which undoubtedly corruption is perceived to exists in every phase. The aim of this study is to identify opportunities of corruption across FDM phases. The study presents a case study of Kelantan using the quantitative research approach which utilises questionnaire with government and private agencies. Further to that, this paper proved that opportunities for corruption may occur at every phase, undoubtedly response and recovery phase especially activities involving fund and donation are riskier. The findings are hoped to assist in developing an improved FDM in term of increased transparency.
Bosnic-Anticevich, Sinthia Z; Stuart, Meg; Mackson, Judith; Cvetkovski, Biljana; Sainsbury, Erica; Armour, Carol; Mavritsakis, Sofia; Mendrela, Gosia; Travers-Mason, Pippa; Williamson, Margaret
Background Inter-professional learning has been promoted as the solution to many clinical management issues. One such issue is the correct use of asthma inhaler devices. Up to 80% of people with asthma use their inhaler device incorrectly. The implications of this are poor asthma control and quality of life. Correct inhaler technique can be taught, however these educational instructions need to be repeated if correct technique is to be maintained. It is important to maximise the opportunities...
Yanev, Y.L.; Cherif, S.
Full text: 'Knowledge Management caters to the critical issues of organizational adaptation, survival and competence in face of increasingly discontinuous change of environment. Essentially, it embodies organizational processes that seek synergistic combination of data and information processing capacity of information technologies, and the creative and innovative capacity of human beings' (Malhotra 1997). International organizations are coming to view knowledge as their most valuable and strategic resource, and bringing that knowledge to bear on problems and opportunities as their most important capability. It is being realised that to remain geared to the evolving needs of their Member States it is a must to explicitly manage all intellectual resources and capabilities of the organization. To this end, many international organizations have initiated a range of knowledge management projects and programs. The primary focus of these efforts has been on developing new applications of information technology to support the digital capture, storage, retrieval and distribution of an organization's documented knowledge but also capturing valuable tacit knowledge existing within peoples' heads, augmented or shared via interpersonal interaction and social relationships. Numerous technical and organizational initiatives have been aligned and integrated, providing a comprehensive infrastructure to support knowledge management processes. But while the appropriate infrastructure can enhance an organization's ability to create and exploit knowledge, it does not insure that the organization is making the best investment of its resources or that it is managing the right knowledge in the right way. Against the background of these trends and the opportunities and challenges they present, the Agency has been active in establishing knowledge management as a crosscutting activity that includes both assisting Member States in managing their own nuclear knowledge assets but also in
Babl, F. E.; Sheriff, N.; Borland, M.; Acworth, J.; Neutze, J.; Krieser, D.; Ngo, P.; Schutz, J.; Thomson, F.; Cotterell, E.; Jamison, S.; Francis, P.
Objectives: To compare clinical practice guideline (CPG) recommendations and reported physician management of acute paediatric asthma in the 11 largest paediatric emergency departments, all of which have CPGs, in Australia (n= 9) and New Zealand (n= 2). All 11 sites participate in the Paediatric
Pei, Qing-Mei; Jiang, Ping; Yang, Min; Qian, Xue-Jiao; Liu, Jiang-Bo; Kim, Sung-Ho
Asthma is a chronic respiratory disease characterized by reversible airway obstruction with persistent airway inflammation and airway remodelling, which is associated with increased airway smooth muscle (ASM) mass. Roxithromycin (RXM) has been widely used in asthma treatment; however, its mechanism of action is poorly understood. Vascular endothelial growth factor (VEGF) has been implicated in inflammatory and airway blood vessel remodelling in patients with asthma, and shown to promote ASM cell proliferation. Here, we investigated the effect of RXM on VEGF-induced ASM cell proliferation and attempted to elucidate the underlying mechanisms of action. We tested the effect of RXM on proliferation and cell cycle progression, as well as on the expression of phospho-VEGF receptor 2 (VEGFR2), phospho-extracellular signal-regulated kinase 1/2 (ERK1/2), phospho-Akt, and caveolin-1 in VEGF-stimulated ASM cells. RXM inhibited VEGF-induced ASM cell proliferation and induced cell cycle arrest. Additionally, VEGF-induced ASM cell proliferation was suppressed by inhibiting the activity of ERK1/2, but not that of Akt. Furthermore, RXM treatment inhibits VEGF-induced activation of VEGFR2 and ERK and downregulation of caveolin-1 in a dose-dependent manner. RXM also inhibited TGF-β-induced VEGF secretion by ASM cells and BEAS-2B cells. Collectively, our findings suggest that RXM inhibits VEGF-induced ASM cell proliferation by suppression of VEGFR2 and ERK1/2 activation and caveolin-1 down-regulation, which may be involved in airway remodelling. Further elucidation of the mechanisms underlying these observations should enable the development of treatments for smooth muscle hyperplasia-associated diseases of the airway such as asthma. - Highlights: • RXM inhibited VEGF-induced ASM cell proliferation and induced cell cycle arrest. • VEGF-induced cell proliferation was suppressed by inhibiting the activity of ERK1/2. • RXM inhibits activation of VEGFR2 and ERK and downregulation
Pei, Qing-Mei, E-mail: firstname.lastname@example.org [Department of Radiology, Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin (China); Jiang, Ping, E-mail: email@example.com [Department of Respiration, Tianjin First Central Hospital, Tianjin (China); Yang, Min, E-mail: YangMin@163.com [Department of Respiration, Tianjin First Central Hospital, Tianjin (China); Qian, Xue-Jiao, E-mail: firstname.lastname@example.org [Department of Respiration, Tianjin First Central Hospital, Tianjin (China); Liu, Jiang-Bo, E-mail: LJB1984@163.com [Department of Respiration, Tianjin First Central Hospital, Tianjin (China); Kim, Sung-Ho, E-mail: email@example.com [Department of Respiration, Tianjin First Central Hospital, Tianjin (China)
Asthma is a chronic respiratory disease characterized by reversible airway obstruction with persistent airway inflammation and airway remodelling, which is associated with increased airway smooth muscle (ASM) mass. Roxithromycin (RXM) has been widely used in asthma treatment; however, its mechanism of action is poorly understood. Vascular endothelial growth factor (VEGF) has been implicated in inflammatory and airway blood vessel remodelling in patients with asthma, and shown to promote ASM cell proliferation. Here, we investigated the effect of RXM on VEGF-induced ASM cell proliferation and attempted to elucidate the underlying mechanisms of action. We tested the effect of RXM on proliferation and cell cycle progression, as well as on the expression of phospho-VEGF receptor 2 (VEGFR2), phospho-extracellular signal-regulated kinase 1/2 (ERK1/2), phospho-Akt, and caveolin-1 in VEGF-stimulated ASM cells. RXM inhibited VEGF-induced ASM cell proliferation and induced cell cycle arrest. Additionally, VEGF-induced ASM cell proliferation was suppressed by inhibiting the activity of ERK1/2, but not that of Akt. Furthermore, RXM treatment inhibits VEGF-induced activation of VEGFR2 and ERK and downregulation of caveolin-1 in a dose-dependent manner. RXM also inhibited TGF-β-induced VEGF secretion by ASM cells and BEAS-2B cells. Collectively, our findings suggest that RXM inhibits VEGF-induced ASM cell proliferation by suppression of VEGFR2 and ERK1/2 activation and caveolin-1 down-regulation, which may be involved in airway remodelling. Further elucidation of the mechanisms underlying these observations should enable the development of treatments for smooth muscle hyperplasia-associated diseases of the airway such as asthma. - Highlights: • RXM inhibited VEGF-induced ASM cell proliferation and induced cell cycle arrest. • VEGF-induced cell proliferation was suppressed by inhibiting the activity of ERK1/2. • RXM inhibits activation of VEGFR2 and ERK and downregulation
To, Masako; Tajima, Makoto; Ogawa, Cyuhei; Otomo, Mamoru; Suzuki, Naohito; Sano, Yasuyuki
Stimulation to bronchial mucosa is one of the major risk factor of asthma attack. When patients receive surgical intervention and general anesthesia, they are always exposed to stimulation to bronchial mucosa. Prevention method of bronchial asthma attack during surgical intervention is not established yet. We investigated that clinical course of patients with bronchial asthma who received general anesthesia and surgical intervention. Seventy-six patients with bronchial asthma were received general anesthesia and surgical intervention from 1993 to 1998. Twenty-four patients were mild asthmatic patients, 39 were moderate asthmatic patients and 13 were severe asthmatic patients. Preoperative treatment for preventing asthma attack was as follows; Eight patients were given intravenous infusion of aminophylline before operation. Fifty-two patients were given intravenous infusion of aminophylline and hydrocortisone before operation. Three patients were given intravenous infusion of hydrocortisone for consecutive 3 days before operation. Thirteen patients were given no treatment for preventing asthma attack. One patient was suffered from asthma attack during operation. She was given no preventing treatment for asthma attack before operation. Three patients were suffered from asthma attack after operation. No wound dehiscence was observed in all patients. To prevent asthma attack during operation, intravenous infusion of steroid before operation is recommended, when patients with asthma receive general anesthesia and surgical intervention.
Waterman, Robert D.; Langwost, Patricia E.; Waterman, Susan J.
The launch site processing flow involves operations such as functional verification, preflight servicing and launch. These operations often include hazards that must be controlled to protect human life and critical space hardware assets. Existing command and control capabilities are limited to simple limit checking durig automated monitoring. Contingency actions are highly dependent on human recognition, decision making, and execution. Many opportunities for Integrated System Health Engineering and Management (ISHEM) exist throughout the processing flow. This paper will present the current human-centered approach to health management as performed today for the shuttle and space station programs. In addition, it will address some of the more critical ISHEM needs, and provide recommendations for future implementation of ISHEM at the launch site.
Full Text Available The role of e-learning technologies entirely depends on the acceptance and execution of required-change in the thinking and behaviour of the users of institutions. The research are constantly reporting that many e-learning projects are falling short of their objectives due to many reasons but on the top is the user resistance to change according to the digital requirements of new era. It is argued that the suitable way for change management in e-learning environment is the training and persuading of users with a view to enhance their digital literacy and thus gradually changing the users’ attitude in positive direction. This paper discusses change management in transition to e-learning system considering pedagogical, cost and technical implications. It also discusses challenges and opportunities for integrating these technologies in higher learning institutions with examples from Turkey GATA (Gülhane Askeri Tıp Akademisi-Gülhane Military Medical Academy.
Yuan Hui; Wang Li'ao; Su Fenwei; Hu Gang
The dual influences of the resource supply and protection in ecological environments will pose a significant challenge to China's sustainable development. Solid waste management offers opportunities to improve profits by conserving resources and improving environmental performance. This paper examines municipal solid waste (MSW) management in urban Chongqing, the nation's fourth largest municipality after Beijing, Shanghai and Tianjin. In this paper, we will provide information on the quantity and composition of MSW, as well as give an overview of different methods for collection, transport, treatment and disposal of MSW. At present the daily amount of MSW generated per person is about 1.08 kg; food waste accounts for about 59% of total MSW. MSW in Chongqing has a higher moisture content (64.1%) and a lower LHV (3728 kJ/kg) than other cities in Asia, which is an obstruction for incineration. Landfills are the main method of disposal in Chongqing, but pollution caused by simple landfills and lack of backup MSW disposal capacity are becoming major problems in the main districts of Chongqing. In this paper, the challenges being faced and opportunities to MSW in Chongqing are analyzed and some suggestions are given for improving the MSW system in the future
Ruitenburg, Richard Jacob; Braaksma, Anne Johannes Jan; van Diepen, T.
Asset Life Cycle Management concerns the effective management of physical assets over their complete lifetimes, typically lasting decades. Therefore, a large number and a wide variety of challenges and opportunities may need to be dealt with proactively, using limited resources. Therefore, we
Feletto, Eleonora; Lui, Grace Wan Ying; Armour, Carol; Saini, Bandana
This study aimed to investigate the application of a research-based change-management tool, the Pharmacy Change Readiness Wheel (PCRW), in practice, and the impact it had on the implementation of an asthma service (Pharmacy Asthma Management Service or PAMS). All pharmacists implementing the PAMS in the state of New South Wales, Australia, were provided training using a custom-designed module explaining change readiness as it applied to the PAMS. This training and a self-administered PCRW checklist were completed before PAMS implementation. Following PAMS service delivery, semi-structured phone interviews were conducted with the pharmacists and any additional staff involved regarding their experiences of change management. Interviews were transcribed verbatim and content analysed. Thirty seven of the forty five pharmacies who delivered PAMS returned the PCRW checklist (82% response rate) and participants from 29 pharmacies were interviewed (29 pharmacists and six additional staff). Perception of readiness for change before service delivery was remarkably high. From the interviews conducted after service delivery it was evident that systematic management of the practice change using theoretical concepts had not really been undertaken and that many challenges were faced in the implementation of practice change (PAMS). The results of the content analysis from the interviews revealed that factors external or internal to the pharmacy or those related to the individual pharmacist could affect implementation of practice change. Change is not as straightforward as it may appear and is a multi-step process over time. Pharmacists were unaware of this. A change-management framework should be applied to specific services with enough flexibility so that pharmacists can individualise them for their pharmacies. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.
Full Text Available Anthropogenic emissions likely pose serious threat to the stability of our environment; immediate actions are required to change the way the earth’s resources are consumed. Among the many approaches to mitigation of environmental deterioration being considered, the processes for designing, sourcing, producing and distributing products in global markets play a central role. Considerable research effort is being devoted to understanding how organisational initiatives and government policies can be structured to facilitate incorporation of sustainability into design and management of entire supply chain. In this paper, we review the current state of academic research in sustainable supply chain management, and provide a discussion of future direction and research opportunities in this field. We develop an integrative framework summarising the existing literature under four broad categories: (i strategic considerations; (ii decisions at functional interfaces; (iii regulation and government policies; and (iv integrative models and decision support tools. We aim to provide managers and industry practitioners with a nuanced understanding of issues and trade-offs involved in making decisions related to sustainable supply chain management. We conclude the paper by discussing environmental initiatives in India and the relevance of sustainability discussions in the context of the Indian economy.
Natalie A. DiPietro
Full Text Available As medication therapy management (MTM continues to grow in the profession of pharmacy, careful consideration as to areas for positive patient impact is warranted. Given the current gaps in preconception care in the United States, and the accessibility and expertise of the pharmacist, MTM interventions related to preconception care may be valuable. This paper describes potential for pharmacist intervention in several different areas of preconception care. Notably, targeted medication reviews may be appropriate for interventions such as folic acid recommendations, teratogenic/category X medication management, immunizations, and disease state management. Comprehensive medication reviews may be warranted for selected disease states due to complexity of interventions, such the management of diabetes. Comprehensive medication reviews may also be warranted if several targeted interventions are necessary, or if there are a several medications or disease states requiring intervention. Pharmacists also have important roles in screening, support, and referrals needed for preconception care in the context of MTM. Patients may benefit substantially from pharmacist-directed MTM services related to preconception care. In addition, depending on clinical pharmacy service contracts and billing opportunities, pharmacists may be reimbursed for providing these services, generating sustainable revenue while fulfilling an important public health need. Type: Idea Paper
Prins, L.C.J.; van Son, M.A.C.; van Keimpema, A.R.J.; van Ranst, D.; Antonissen-Pommer, A.M.; Meijer, J.W.G.; Pop, V.J.M.
Objective: Within the asthma population, difficult asthma (DA) is a severe condition in which patients present with frequent exacerbations, hospitalizations and emergency room visits. The identification and treatment of psychopathology is included in the management of DA. Psychopathology is supposed
Blakey, John D; Woolnough, Kerry; Fellows, Jodie; Walker, Samantha; Thomas, Mike; Pavord, Ian D
Asthma guidelines focus on day-to-day control of symptoms. However, asthma attacks remain common. They continue to cause mortality and considerable morbidity, and are a major financial burden to the UK National Health Service (NHS) and the wider community. Asthma attacks have chronic consequences, being associated with loss of lung function and significant psychological morbidity. In this article we argue that addressing daily symptom control is only one aspect of asthma treatment, and that there should be a more explicit focus on reducing the risk of asthma attacks. Management of future risk by general practitioners is already central to other conditions such as ischaemic heart disease and chronic renal impairment. We therefore propose a revised approach that separately considers the related domains of daily control and future risk of asthma attack. We believe this approach will have advantages over the current 'stepwise' approach to asthma management. It should encourage individualised treatment, including non-pharmacological measures, and thus may lead to more efficacious and less harmful management strategies. We speculate that this type of approach has the potential to reduce morbidity and healthcare costs related to asthma attacks.
Full Text Available Change management is a systematic process of applying different knowledge, procedures and means required for the change to reflect on people that will be influenced by it. The goal is to achieve the desired business solution in an organized and methodical way. We can witness that changes occur on a daily basis in life of every individual, but also of a business organization. Therefore, managers play an important role during the period in which changes are introduced, because their task is to interpret the process for their employees and to explain what these changes mean specifically for them. Changes in business organizations are inevitable if a business system is to survive in its environment and on the market in general. Employee awareness and responsibility in all these processes is important, and so is the positive influence of managers on motivation of employees. This is best achieved by introducing team work and training for the entire business organization. In this way everyone will have the opportunity to see what is best for them and they will accept the newly made changes more easily. Most of these issues were included in the survey that was conducted.
Wright, Sarah; Chapman, Peter T; Frampton, Christopher; O'Donnell, John L; Raja, Rafi; Stamp, Lisa K
Management of gout is frequently suboptimal. The aim of this study was to determine the proportion of patients presenting to Christchurch Hospital for a gout flare and to determine whether management for both acute flares and urate lowering was in accordance with international recommendations. A retrospective audit was undertaken of all admissions to Christchurch Hospital from June 1, 2013, to May 31, 2014, in which gout was coded as a primary or secondary discharge diagnosis. Information including demographics, comorbidities, concomitant medications, treatment of acute gout, and urate lowering was collected. A total of 235 acute admissions for gout in 216 individuals were identified. Eleven individuals had 2 admissions and 4 individuals had 3 admissions. In 95/235 admissions (40.4%), gout was the primary diagnosis. Gout accounted for 95/77,321 (0.12%) of acute admissions. The treatment of acute gout was prednisone monotherapy in 170/235 (72.3%) of admissions. Serum urate was measured at some point during 123/235 (52.3%) of admissions, with only 19/123 (15.4%) at target urate level (gout are similar to that observed in other studies. Failure to initiate, change, or recommend alterations in urate-lowering therapy to achieve target urate in people with gout admitted to hospital represents a significant lost opportunity to improve longterm gout management.
Hadjieva-Zaharieva, R.; Dimitrova, E.; Buyle-Bodin, Francois
Building waste recycling as aggregates is a modern approach for preventing environmental pollution through both reducing the stocks of waste and decreasing the use of natural aggregates. The reuse of building waste is a relatively new issue for Bulgaria despite the existing considerable quantity of building waste and the significant changes in the environmental rules applied. The paper discusses generated and potential waste streams in Bulgaria in the context of the social and economic restructuring and recent urban development undergone by the country. The main preliminary conditions for developing the recycling activity such as: streams of building waste, experience in recycling, technical and environmental standardization, appropriate technologies, etc. are examined. The authors analyze current practice and research activities with regard to the implementation of advanced EU building-waste recycling methods. Conclusions are drawn about existing opportunities and the priorities of the needed building waste management strategy in the country
The technical arguments for massive expansion of nuclear power generation are convincing, but such a renaissance requires public acceptance. For diehard nuclear opponents, criticism now focuses on its Achilles heel - the unsolved (and often claimed to be insoluble) problem of disposal of the resultant long-lived waste. In fact, the geological disposal of nuclear waste can be managed safely with existing technology and should really be touted as one of the advantages of this option. Clearly, there is a major challenge in communicating disposal safety to key stakeholders in order to realise this benefit. Nevertheless, the growth of environmental concern about global warming and the present economic climate may present opportunities to initiate dialogue with relevant communities, allowing the attractions of hosting future disposal facilities to be seen. Rather than being the archetypal focus for NIMBY reactions, maybe within a few years we can look forward to growing competition to host geological repositories for radioactive waste.(Author)
Full Text Available Asthma is a chronic, reversible obstructive disease that when in exacerbation can present to the emergency department in a spectrum of severity. Prompt recognition of the potentially severely ill asthmatic requires a careful history and physical exam while considering alternative diagnoses for the presenting symptoms. Early administration of salbutamol and corticosteroids is indicated in almost all patients with other medications such as ipratropium and magnesium and supportive modalities like BiPAP reserved for sicker patients. The global impact of asthma is increasing, especially amongst children. While the benign clinical presentation is most common and mortality has decreased in recent decades due to improved recognition and care, the ubiquity of the condition and frequent lack of regular outpatient management contribute to the disease claiming 250,000 lives worldwide annually. The emergency physician must be prepared to assess and appropriately manage both the young child with a mild wheeze and the adult in respiratory failure.
Saini, B; Krass, I; Smith, L; Bosnic-Anticevich, S; Armour, C
Asthma is one of the most common chronic conditions affecting the Australian population. Amongst primary healthcare professionals, pharmacists are the most accessible and this places pharmacists in an excellent position to play a role in the management of asthma. Globally, trials of many community pharmacy-based asthma care models have provided evidence that pharmacist delivered interventions can improve clinical, humanistic and economic outcomes for asthma patients. In Australia, a decade of coordinated research efforts, in various aspects of asthma care, has culminated in the implementation trial of the Pharmacy Asthma Management Service (PAMS), a comprehensive disease management model.There has been research investigating asthma medication adherence through data mining, ways in which usual asthma care can be improved. Our research has focused on self-management education, inhaler technique interventions, spirometry trials, interprofessional models of care, and regional trials addressing the particular needs of rural communities. We have determined that inhaler technique education is a necessity and should be repeated if correct technique is to be maintained. We have identified this effectiveness of health promotion and health education, conducted within and outside the confines of the pharmacy, in public for a and settings such as schools, and established that this outreach role is particularly well received and increases the opportunity for people with asthma to engage in their asthma management.Our research has identified that asthma patients have needs which pharmacists delivering specialized models of care, can address. There is a lot of evidence for the effectiveness of asthma care by pharmacists, the future must involve integration of this role into primary care.
Full Text Available Asthma is one of the most common chronic conditions affecting the Australian population. Amongst primary healthcare professionals, pharmacists are the most accessible and this places pharmacists in an excellent position to play a role in the management of asthma. Globally, trials of many community pharmacy-based asthma care models have provided evidence that pharmacist delivered interventions can improve clinical, humanistic and economic outcomes for asthma patients. In Australia, a decade of coordinated research efforts, in various aspects of asthma care, has culminated in the implementation trial of the Pharmacy Asthma Management Service (PAMS, a comprehensive disease management model. There has been research investigating asthma medication adherence through data mining, ways in which usual asthma care can be improved. Our research has focused on self-management education, inhaler technique interventions, spirometry trials, interprofessional models of care, and regional trials addressing the particular needs of rural communities. We have determined that inhaler technique education is a necessity and should be repeated if correct technique is to be maintained. We have identified this effectiveness of health promotion and health education, conducted within and outside the confines of the pharmacy, in public for a and settings such as schools, and established that this outreach role is particularly well received and increases the opportunity for people with asthma to engage in their asthma management. Our research has identified that asthma patients have needs which pharmacists delivering specialized models of care, can address. There is a lot of evidence for the effectiveness of asthma care by pharmacists, the future must involve integration of this role into primary care.
Elston H. Dzus
Full Text Available Woodland caribou conservation has been the topic of much debate for the past few decades. By the late 1970s there was growing concern about declining woodland caribou populations and the interaction between industrial activities and woodland caribou. Initial concerns led to the closure of the licensed hunting season in 1981. Early confrontation between government and industry in the late 1980s transformed into a series of evolving collaborative ventures. Improving our understanding of the basic ecology of woodland caribou in Alberta was at the center of early research efforts; more recent studies have examined the effects of industrial activities on caribou and effectiveness of various mitigation factors. Despite having amassed an impressive body of information from a research and monitoring perspective, progress on implementing effective management actions has been less dramatic. Industry has endured significant costs implementing a variety of perceived conservation initiatives, but caribou populations continued to decline through the last few decades. While some parties feel more research is needed, there is growing consensus that changes to habitat as induced by human activities are important factors influencing current caribou declines. Predation is a proximate cause of most caribou mortality. Climate change mediated alterations to habitat and predator-prey interactions remain a key source of uncertainty relative to future caribou population trends. Management actions will need to deal with long term habitat changes associated with human land use and short term implications of increased predation. In 2005, the provincial minister responsible for caribou conservation responded to the draft 2004 recovery plan and created the Alberta Caribou Committee (ACC. The goal of the ACC is to maintain and recover woodland caribou in Alberta’s forest ecosystems while providing opportunities for resource development, following guidance provided by the
'Full text:' Deregulation, distributed generation, combined heat and power, renewables, fuel cells, hydrogen. Power companies are facing a rapidly evolving environment that is testing their ability to effectively deploy capital and earn profits. While recent deregulation trends have shifted the structure of power markets into separating generators from distributors, the improving economic value proposition offered by smaller scale distributed generation technologies - such as fuel cells - would seem to be a conflicting development. In this complex and changing environment, decisions based on the economic reality of the capital markets are likely to prevail. By examining the opportunity to enhance risk management offered by stationary fuel cells, particularly in CHP applications, we provide a context for the issues being discussed in today's sessions focusing on power companies and electric utilities. Our risk management perspective suggests a pathway for implementing fuel cells in combined heat and power applications that large power generators can introduce in increasingly smaller sizes. With capital costs of fuel cells high and risk tolerance of power companies low, the challenge for smaller technology developers will be to reduce the apparently long time horizon that persists for substantial deployment. (author)
Full Text Available Hyekyun Rhee,1 James Allen,2 Jennifer Mammen,1 Mary Swift21School of Nursing, 2Department of Computer Science, University of Rochester, Rochester, NY, USAPurpose: Adolescents report high asthma-related morbidity that can be prevented by adequate self-management of the disease. Therefore, there is a need for a developmentally appropriate strategy to promote effective asthma self-management. Mobile phone-based technology is portable, commonly accessible, and well received by adolescents. The purpose of this study was to develop and evaluate the feasibility and acceptability of a comprehensive mobile phone-based asthma self-management aid for adolescents (mASMAA that was designed to facilitate symptom monitoring, treatment adherence, and adolescent–parent partnership. The system used state-of-the-art natural language-understanding technology that allowed teens to use unconstrained English in their texts, and to self-initiate interactions with the system.Materials and methods: mASMAA was developed based on an existing natural dialogue system that supports broad coverage of everyday natural conversation in English. Fifteen adolescent–parent dyads participated in a 2-week trial that involved adolescents' daily scheduled and unscheduled interactions with mASMAA and parents responding to daily reports on adolescents' asthma condition automatically generated by mASMAA. Subsequently, four focus groups were conducted to systematically obtain user feedback on the system. Frequency data on the daily usage of mASMAA over the 2-week period were tabulated, and content analysis was conducted for focus group interview data.Results: Response rates for daily text messages were 81%–97% in adolescents. The average number of self-initiated messages to mASMAA was 19 per adolescent. Symptoms were the most common topic of teen-initiated messages. Participants concurred that use of mASMAA improved awareness of symptoms and triggers, promoted treatment adherence and
Farzan, Niloufar; Vijverberg, Susanne J.; Kabesch, Michael; Sterk, Peter J.; Maitland-van der Zee, Anke H.
Asthma is a complex multifactorial disease and it is the most common chronic disease in children. There is a high variability in response to asthma treatment, even in patients with good adherence to maintenance treatment, and a correct inhalation technique. Distinct underlying disease mechanisms in
Coombs, Nicole; Allen, Louise; Cooper, Simon; Cant, Robyn; Beauchamp, Alison; Laszcyk, Jacki; Giannis, Anita; Hopmans, Ruben; Bullock, Shane; Waller, Susan; McKenna, Lisa; Peck, Blake
Objective: This study explored young university students' (aged 18-24 years) health literacy, asthma experiences and help-seeking behaviours to inform the development of a web-based asthma education intervention relevant to this age group. Design: Exploratory mixed-methods design incorporateing a health literacy survey and interviews, plus the…
). Allergy and Asthma Clinic, Red Cross War Memorial Hospital. Mike Levin runs a secondary level asthma/ allergy clinic and does a tertiary allergy session once a week, focusing on difficult asthma and food allergies. He has ...
Full Text Available Energy efficiency represents a key resource for economic and social development, providing substantial benefits to different stakeholders, ranging from the entities which develop energy efficient measures to everyone in society. In addition to cost savings, multiple benefits can be achieved by supporting a better alignment between energy issues and strategic business priorities: e.g., improved competitiveness, profitability, quality, etc. Thus, energy efficiency can be a strategic advantage, not just a marginal issue, for companies. However, most firms, especially small and medium enterprises (SMEs, face many problems and, in some cases, hostility when trying to effectively implement energy efficiency actions. The most dominant barriers are the access to capital and the lack of awareness (especially in terms of life cycle cost effects. The supply chain viewpoint represents one of the main opportunities for overcoming those barriers and improving energy performance even for weaker companies. Since the current literature on energy efficiency and practical approaches to ensure energy efficiency mainly focus on energy performance on a single-firm basis, this paper aims to provide a systematic review of papers on the integration of energy efficiency in supply chain design and management published in academic journal, thereby defining potential research streams to close the gaps in the literature. A number of literature reviews have been published focusing on specific aspects of sustainable or on green supply chain management; however, to the best of our knowledge, no review has focused on the energy efficiency issue. Firstly, the present paper shows how considering energy consumption in supply chain management can contribute to more energy-efficient processes from a systemic point of view. Then, the review methodology used is defined and the sampled papers are analyzed and categorized based on the different approaches they propose. From these
N.A.H. Agatz (Niels); A.M. Campbell (Ann Melissa); M. Fleischmann (Moritz); J.A.E.E. van Nunen (Jo); M.W.P. Savelsbergh (Martin)
textabstractIn this paper, we explain how Internet retailers can learn from proven revenue management concepts and use them to reduce costs and enhance service. We focus on attended deliveries as these provide the greatest opportunities and challenges. The key driver is service differentiation.
Jones, Craig A; Clement, Loran T; Hanley-Lopez, Jean; Morphew, Tricia; Kwong, Kenny Yat Choi; Lifson, Francene; Opas, Lawrence; Guterman, Jeffrey J
Despite more than a decade of education and research-oriented intervention programs, inner city children with asthma continue to engage in episodic "rescue" patterns of healthcare and experience a disproportionate level of morbidity. The aim of this study was to establish and evaluate a sustainable community-wide pediatric asthma disease management program designed to shift inner city children in Los Angeles from acute episodic care to regular preventive care in accordance with national standards. In 1995 the Southern California Chapter of the Asthma and Allergy Foundation of America (AAFA), the Los Angeles County Department of Health Services (LAC DHS), and the Los Angeles Unified School District (LAUSD) established an agreement to initiate and sustain the Breathmobile Program. This program includes automated case identification, mobile school-based clinics, and highly structured clinical encounters supported by an advanced information technology solution. Interdisciplinary teams of asthma care specialists provide regular and ongoing care to children at school and county clinic sites over a wide geographic area of urban Los Angeles. Each team operates in a specially equipped mobile clinic (Breathmobile), efficiently moving a structured healthcare process to school and county clinic sites with large numbers of children. Demographic, clinical, and participation data is tracked carefully in an electronic medical record system. Program operations, clinical oversight, and patient tracking are centralized at a care coordination center. Clinical operations and methods have been replicated in fixed specialty clinic sites at the Los Angeles County + University of Southern California Medical Center. Clinical and process measures are regularly evaluated to assure quality, plan iterative improvement, and support evidence-based care. Four Breathmobiles deliver ongoing care at more than 90 school sites. The program has engaged over five thousand patients and their families in a
Ulrik, Charlotte S
PURPOSE OF REVIEW: Obesity has significant negative impact on asthma control and risk of exacerbations. The purpose of this review is to discuss recent studies evaluating the effects of weight reduction on asthma control in obese adults. RECENT FINDINGS: Clinical studies have shown that weight...... reduction in obese patients is associated with improvements in symptoms, use of controller medication, and asthma-related quality of life together with a reduction in the risk for severe exacerbations. Furthermore, several studies have also revealed improvements in lung function and airway responsiveness...... reduction in obese adults with asthma leads to an overall improvement in asthma control, including airway hyperresponsiveness and inflammation. Weight reduction should be a cornerstone in the management of obese patients with asthma....
Koster, Ellen S; Philbert, Daphne; de Vries, Tjalling W; van Dijk, Liset; Bouvy, Marcel L
Medication adherence rates often decline as children become teenagers. Effective adherence-enhancing interventions for adolescents are lacking. The objective of this study was to assess adolescent asthmatics needs and preferences regarding medication counseling and support, with focus on new media. Three focus groups including 21 asthmatic adolescents recruited from both primary and secondary care were held to explore needs and preferences regarding asthma-self management. Questions concerned adherence behavior and needs and preferences in adherence support with focus on new media (mobile technology, social media, health games). Forgetting was mentioned as major reason for not using medication as prescribed. Adolescents also mentioned lack of perceived need or beneficial effects. Parents mainly play a role in reminding to take medication and collecting refills. The suggested strategies to support self-management included smartphone applications with a reminder function and easy access to online information. Participants were positive about sharing of experiences with other teenagers. Forgetfulness is a major reason for non-adherence in adolescents. Furthermore, our results suggest use of peer support may be helpful in promoting good medication use. Future interventions should be aimed at providing practical reminders and should be modifiable to individual preferences.
Full Text Available Thomas SandströmDepartment of Respiratory Medicine and Allergy, University Hospital, Umeå, SwedenAbstract: Immunoglobulin E (IgE is central to the pathophysiology of allergic asthma. Omalizumab, an anti-IgE monoclonal antibody, binds to the FcεRI binding site on free IgE. As a result, circulating free IgE is reduced, IgE is prevented from attaching to mast cells and basophils, and FcεRI receptor expression is down-regulated. The inflammatory response to allergens and the acute and chronic effector phases of allergic inflammation are thereby attenuated. In clinical trials in adults and adolescents, omalizumab reduced asthma exacerbations, severe asthma exacerbations, inhaled corticosteroid requirements, and emergency visits, as well as significantly improving asthma-related quality of life, morning peak expiratory flow and asthma symptom scores in patients with severe allergic (IgE-mediated asthma. Results from clinical trials in children (< 12 years are consistent with those in the adult population. It is difficult to predict which patients will respond to omalizumab. Responders to omalizumab should be identified after a 16-week trial of therapy using the physician’s overall assessment. When treatment is targeted to these responders, omalizumab provides a cost-effective therapy for inadequately controlled severe allergic (IgE-mediated asthma. Long-term therapy with omalizumab shows the potential for disease-modification in asthma. Ongoing studies are also evaluating the use of omalizumab in other non-asthma IgE-mediated conditions.Keywords: omalizumab, IgE, allergic asthma
Price, David; Fletcher, Monica; van der Molen, Thys
Background: Asthma is one of the most common chronic diseases in the world, and previous studies have reported low levels of control. Recent developments in the availability and use of online sources of information about asthma might add to patients’ knowledge and help improve control. Aims: To investigate whether asthma control has improved by assessing levels of symptoms, exacerbations and Global Initiative for Asthma-defined control in a real-life population of patients who use the Internet and social media, as well as evaluate patient perception of control and attitudes to asthma. Methods: Online surveys were conducted among 8,000 patients with asthma (aged 18–50 years, ⩾2 prescriptions in the previous 2 years, use of social media) from 11 European countries. Results: Levels of asthma control were low: 45% of respondents had uncontrolled asthma. Acute exacerbations were common: 44% of respondents reported having used oral steroids for asthma in the previous 12 months, 24% had visited an emergency department and 12% had been hospitalised. More than 80% of respondents (overall, and among those with a history of exacerbations) considered their asthma to be controlled. Of those who had an exacerbation requiring oral steroids, 75% regarded their asthma as not serious. Conclusions: Asthma control in Europe remains poor; symptoms and exacerbations are common. Many patients regard their asthma as controlled and not serious despite experiencing symptoms and exacerbations. There is a need to assess patients’ control, risk and inhaler technique, and to ensure that patients are prescribed, and take, appropriate treatments. PMID:24921985
Elias, Pierre; Rajan, Nithin O; McArthur, Kara; Dacso, Clifford C
Asthma is the most common chronic disease in childhood, disproportionately affecting urban, minority, and disadvantaged children. Individualized care plans supported by daily lung-function monitoring can reduce morbidity and mortality. However, despite 20 years of interventions to increase adherence, only 50% of US youth accurately follow their care plans, which leads to millions of preventable hospitalizations, emergency room visits, and sick days every year. We present a feasibility study of a novel, user-centered approach to increasing young people's lung-function monitoring and asthma self-care. Promoting Lung Assessment in Youth (PLAY) helps young people become active managers of their asthma through the Web 2.0 principles of participation, cocreation, and information sharing. Specifically, PLAY combines an inexpensive, portable spirometer with the motivational power and convenience of mobile phones and virtual-community gaming. The objective of this study was to develop and pilot test InSpire, a fully functional interface between a handheld spirometer and an interactive game and individualized asthma-care instant-messaging system housed on a mobile phone. InSpire is an application for mobile smartphones that creates a compelling world in which youth collaborate with their physicians on managing their asthma. Drawing from design-theory on global timer mechanics and role playing, we incentivized completing spirometry maneuvers by making them an engaging part of a game young people would want to play. The data can be sent wirelessly to health specialists and return care recommendations to patients in real-time. By making it portable and similar to applications normally desired by the target demographic, InSpire is able to seamlessly incorporate asthma management into their lifestyle. We describe the development process of building and testing the InSpire prototype. To our knowledge, the prototype is a first-of-its kind mobile one-stop shop for asthma management
American Academy of Allergy Asthma & Immunology Menu Search Main navigation Skip to content Conditions & Treatments Allergies Asthma Primary Immunodeficiency Disease Related Conditions Drug Guide Conditions Dictionary Just ...
American Academy of Allergy Asthma & Immunology Menu Search Main navigation Skip to content Conditions & Treatments Allergies Asthma Primary Immunodeficiency Disease Related Conditions Drug Guide Conditions Dictionary Just ...
Koster, E.S.; Philbert, D.; Dijk, L. van; Vries, T.W. de; Bouvy, M.L.
Background: Medication adherence rates often decline as children become teenagers. Effective adherence-enhancing interventions for adolescents are lacking. The objective of this study was to assess adolescent asthmatics needs and preferences regarding medication counseling and support, with focus on new media. Methods: Three focus groups including 21 asthmatic adolescents recruited from both primary and secondary care were held to explore needs and preferences regarding asthma-self management...
Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA and World Allergy Organization (WAO document endorsed by Allergic Rhinitis and its Impact on Asthma (ARIA and Global Allergy and Asthma European Network (GA2LEN
Full Text Available Abstract Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD has led INTERASMA (Global Asthma Association and WAO to take a position on the role of the small airways in these diseases. Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA2LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change. The small airways (defined as those with an internal diameter <2 mm are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction. In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 μm], ensure more extensive deposition in the lung periphery than large molecules have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant. Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled
Bellazzi, Riccardo; Dagliati, Arianna; Sacchi, Lucia; Segagni, Daniele
The so-called big data revolution provides substantial opportunities to diabetes management. At least 3 important directions are currently of great interest. First, the integration of different sources of information, from primary and secondary care to administrative information, may allow depicting a novel view of patient's care processes and of single patient's behaviors, taking into account the multifaceted nature of chronic care. Second, the availability of novel diabetes technologies, able to gather large amounts of real-time data, requires the implementation of distributed platforms for data analysis and decision support. Finally, the inclusion of geographical and environmental information into such complex IT systems may further increase the capability of interpreting the data gathered and extract new knowledge from them. This article reviews the main concepts and definitions related to big data, it presents some efforts in health care, and discusses the potential role of big data in diabetes care. Finally, as an example, it describes the research efforts carried on in the MOSAIC project, funded by the European Commission. © 2015 Diabetes Technology Society.
Triay, I.R.; Wu, C.F.; Moody, D.C.; Jennings, S.G.
The opening of the Waste Isolation Pilot Plant (WIPP) for disposal of transuranic (TRU) waste in March of 1999, the granting of the Hazardous Waste Facility Permit in November 1999, and over two years of operational experience have demonstrated the Department of Energy's (DOE'S) capability in closing the nuclear energy cycle. While these achievements resolved several scientific, engineering, regulatory and political issues, the DOE has identified a new set of challenges that represent opportunities for improving programmatic efficiency, cost-effectiveness, and operational safety in managing the nation's TRU waste. The DOE has recognized that the complex administrative and regulatory requirements for characterization, transportation and disposal of TRU waste are costly (1). A review by the National Academy of Sciences (NAS) states that these requirements lead to inefficient waste characterization, handling and transportation operations that in turn can lead to unnecessary radiation exposure to workers without a commensurate decrease in risk to the public and the environment (2). This paper provides an overview of the status of the WJPP repository, explains the principles of the proposed commercial business approach, and describes some of the proposed major enhancements of the TRU waste transportation systems. The DOE is developing a remote-handled (RH) waste program to enable emplacement of RH waste at WPP. This program includes appropriate facility modifications and regulatory changes (3).
... My Child Doesn't Take His or Her Asthma Medication? KidsHealth / For Parents / What if My Child Doesn't Take His or Her Asthma Medication? ... When to Go to the ER if Your Child Has Asthma Asthma Managing Asthma Asthma Center How Do Asthma ...
Ducharme, Francine M; Noya, Francisco; McGillivray, David; Resendes, Sandy; Ducharme-Bénard, Stéphanie; Zemek, Roger; Bhogal, Sanjit Kaur; Rouleau, Rachel
Despite strong recommendations in the asthma guidelines, the use of written self-management plans remains low among asthmatic patients. To develop a written self-management plan, based on scientific evidence and expert opinions, in a format intended to facilitate its dispensing by health care professionals, and to test the perception of its relevance and clarity by asthmatic children, adolescents and adults. Inspired by previously tested self-management plans, surveys of asthma educators, expert opinions and the 2004 Canadian Asthma Guidelines, the authors simultaneously developed French and English versions of a written self-management plan that coupled with a prescription. The self-management plan was tested in parents and their asthmatic children (aged one to 17 years), and it was revised until 85% clarity and perceived relevance was achieved. Ninety-seven children and their parents were interviewed. Twenty per cent had a self-management plan. On the final revision, nearly all items were clear and perceived relevant by 85% or more of the interviewees. Two self-management plans were designed for clinics and acute care settings, respectively. The plans are divided into three control zones identified by symptoms with optional peak flow values and symbolized by traffic light colours. They are designed in triplicate format with a prescription slip, a medical chart copy and a patient copy. The written self-management plans, based on available scientific evidence and expert opinions, are clear and perceived to be relevant by children, adolescents and their parents. By incorporating the prescription and chart copies, they were designed to facilitate dispensing by physicians in both clinics and acute care settings.
JAGL differs from the Global Initiative for Asthma Guideline (GINA in that the former emphasizes long-term management of childhood asthma based on asthma severity and early diagnosis and intervention at <2 years and 2–5 years of age. However, a management method, including step-up or step-down of long-term management agents based on the status of asthma symptoms, is easy to understand and thus JAGL is suitable for routine medical treatment. JAGL also introduced treatment and management using a control test for children, recommending treatment and management aimed at complete control through avoiding exacerbation factors and appropriate use of antiinflammatory agents.
Chen, Yi-Dan; Liang, Zhong-Yuan; Cen, Yan-Yan; Zhang, He; Han, Mei-Gui; Tian, Yun-Qiao; Zhang, Jie; Li, Shu-Jun; Yang, Da-Sheng
The purpose of the present study was to develop oral dispersible tablets containing prednisolone (PDS)-loaded chitosan nanoparticles using microcrystalline cellulose (MCC 101), lactose, and croscarmellose sodium (CCS). The PDS-loaded chitosan nanoparticles were formulated by ionotropic external gelation technique in order to enhance the solubility of PDS in salivary pH. Prepared nanoparticles were used for the development of oral fast disintegrating tablets by direct compression method. The prepared tablets were evaluated for disintegration time (DT), in vitro drug release (DR), thickness, weight variation, drug content uniformity, friability, and hardness. The effect of concentrations of the dependent variables (MCC, lactose, CCS) on DT and in vitro DR was studied. Fast disintegrating tablets of PDS can be prepared by using MCC, CCS, and lactose with enhanced solubility of PDS. The minimum DT was found to be 15 seconds, and the maximum DR within 30 minutes was 98.50%. All independent variables selected for the study were statistically significant. Oral fast disintegrating tablets containing PDS nanoparticles could be the better choice for the pediatric patients that would result in better patient compliance. From this study, it can be concluded that fast disintegrating tablets could be a potential drug delivery technology for the management of asthma in pediatrics. PMID:26640367
Colice, Gene L
The goal of asthma therapy is to reduce symptoms to the extent that patients can lead active, unlimited lives and to minimize concern about exacerbations. Unfortunately, despite advances in our understanding of the pathophysiology of asthma and the existence of consensus asthma-management guidelines, patients with asthma still suffer considerable morbidity and, on rare occasions, death. Part of the reason for suboptimal asthma control is poor adherence, by both providers and patients, to the recommended asthma regimens and guidelines. However, even under the ideal circumstances of a motivated patient and a knowledgeable physician, the available asthma drugs are not effective in all patients at all times. The market for asthma drugs has been dynamic; numerous new products have recently been approved for marketing by the Food and Drug Administration. Unfortunately, the products recently approved and those likely to enter the market soon mostly are either reformulations or combinations of established molecules. Developing new drugs to treat asthma, particularly with novel anti-inflammatory properties, should be a priority.
... Staying Safe Videos for Educators Search English Español Asthma KidsHealth / For Parents / Asthma What's in this article? ... I Know? Print en español Asma What Is Asthma? Asthma is a condition that causes breathing problems. ...
This presentation was given at the 2016 Annual Conference of the Prognostics and Health Management Society. It covers the current status and challenges and opportunities of prognostics and health management of wind turbines.
Price, David; Fletcher, Monica; van der Molen, Thys
BACKGROUND: Asthma is one of the most common chronic diseases in the world, and previous studies have reported low levels of control. Recent developments in the availability and use of online sources of information about asthma might add to patients' knowledge and help improve control. AIMS: To
Celiker, V; Basgül, E; Karakaya, G; Oguzalp, H; Bozkurt, B; Kalyoncu, A F
Analgesic intolerance (AI) appears in approximately 1 % of the general population. The triad of bronchial asthma, nasal polyposis, and analgesic intolerance is called analgesic-induced asthma (AIA). These patients are frequently referred to adult allergy clinics for preoperative evaluation for possible analgesic cross reactivity and intolerance to anesthetic agents. To determine allergic problems related to anesthesia and postoperative pain management in AI patients with and without asthma. The medical records of 45 patients who had been diagnosed with AI between January 1991 and December 2002 in the adult allergy unit and who underwent surgery in the same hospital in the last 4 years were retrospectively analyzed. The mean age of the patients was 44.4 13.4 years and 30 (66.6 %) were female. Thirty-six (80 %) had AIA, 34 (75.6 %) had persistent allergic rhinitis and 21 (46.7 %) had nasal polyps. Fifty-one surgical procedures were performed in 45 patients, in whom ear, nose and throat surgery was the main procedure (64.7 %). Anesthesia was induced with propofol, fentanyl, and vecuronium and was maintained by sevoflurane or isoflurane. Fentanyl was used for early postoperative pain relief. No complications appeared in relation to anesthesia or early pain management except in a 44-year-old AIA woman who had a reaction in the postoperative period after receiving an inappropriate analgesic. None of the patients had anesthesia-related allergic problems. Atropine and diazepam in the premedication, propofol and fentanyl during induction, muscle relaxation facilitation by vecuronium, and sevoflurane or isoflurane for maintenance seem to be a safe general anesthetic choice for analgesic intolerant patients with and without asthma.
Newhouse, Nikki; Martin, Angela; Jawad, Sena; Yu, Ly-Mee; Davoudianfar, Mina; Locock, Louise; Ziebland, Sue; Powell, John
To determine the feasibility of a randomised controlled trial (RCT) assessing the effects of an experience-based website as a resource for the self-management of chronic asthma. Feasibility, single-blind RCT in 2 regions of England. Randomisation used computer-generated random number sequence in a 1:1 ratio, after baseline data collection, to website access for 2 weeks. Adults (age ≥18 years), with clinically diagnosed asthma as coded in their primary care electronic record, prescribed inhaled corticosteroids for at least 3 months in the previous year, were recruited from 9 general practices. The EXPERT asthma intervention is an interactive PC/laptop/tablet/smartphone compatible website designed with extensive input from adults with asthma. It provides experience-based information and aims to support subjective perception of self-efficacy, self-management and improve health status. Primary outcomes were consent/recruitment, website usage and completion of outcome measures. Secondary outcomes included Partners in Health (PIH) questionnaire, the Chronic Disease Self-Efficacy Scale, the SF36 and the E-Health Impact Questionnaire. Participant blinding postrandomisation was not possible. The analysis was blind to allocation. Recruitment target exceeded. 148 participants randomised (73 intervention group). Age range 19-84 years; 59% female. 121 of 148 (84%; 62 intervention group) followed up. The median number of logins was 2 (IQR 2-3, range 1-48). Minimal differences of change from baseline between groups; both showed improvement in health state or management of their condition with no significant differences between arms. No adverse events. Recruitment and retention confirmed feasibility. The trends towards improved outcomes suggest that further research on digital interventions based on exposure to others' personal experiences may be of value in the self-management of chronic asthma. ISRCTN29549695; Results. Published by the BMJ Publishing Group Limited. For
Rusnak, James E.
Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The h...
In a survey of Black and White women managers, Linda M. Hite identifies differences in the managers' perceptions of opportunities available to different race and gender groups. Her findings reveal divergent beliefs about the opportunities for people of color; there is more similarity in Black and White women's views when comparing opportunities…
... Accessed February 28, 2018. Durrani SR, Busse WW. Management of asthma in adolescents and adults. In: Adkinson NF Jr, Bochner BS, Burks AW, et al, eds. Middleton's Allergy: Principles and Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap ...
Vonk, JM; Boezen, HM
PURPOSE OF REVIEW: There still is no cure for asthma. Early identification of patients at risk for disease progression may lead to better treatment opportunities and hopefully better disease outcomes in adulthood. Recent literature on childhood risk factors associated with the outcome of asthma in
Joseph, Christine L M; Lu, Mei; Stokes-Bruzzelli, Stephanie; Johnson, Dayna A; Duffy, Elizabeth; Demers, Michele; Zhang, Talan; Ownby, Dennis R; Zoratti, Edward; Mahajan, Prashant
The emergency department could represent a means of identifying patients with asthma who could benefit from asthma interventions. To assess the initiation of a Web-based tailored asthma intervention in the emergency department of 2 urban tertiary care hospitals. In addition to awareness strategies for emergency department staff (eg, attending nursing huddles, division meetings, etc), recruitment experiences are described for 2 strategies: (1) recruitment during an emergency department visit for acute asthma and (2) recruitment from patient listings (mail or telephone). Patient enrollment was defined as baseline completion, randomization, and completion of the first of 4 online sessions. Of 499 eligible patients 13 to 19 years old visiting the emergency department for asthma during the study period, 313 (63%) were contacted in the emergency department (n = 65) or by mail or telephone (n = 350). Of these, 121 (38.6%) were randomized. Mean age of the study sample was 15.4 years and 88.4% were African American. Refusal rates for emergency department recruitment and mail or telephone were 18.5% (12 of 65) and 16.6% (58 of 350), respectively. On average, emergency department enrollment took 44 to 67 minutes, including downtime. When surveyed, emergency department providers were more positive about awareness activities and emergency department recruitment than were research staff. Emergency department recruitment was feasible but labor intensive. Refusal rates were similar for the 2 strategies. Targeting patients with acute asthma in the emergency department is one way of connecting with youth at risk of future acute events. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Full Text Available Pilar Barranco,1 Elsa Phillips-Angles,2 Javier Dominguez-Ortega,1 Santiago Quirce1 1Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ, CIBER de Enfermedades Respiratorias (CIBERES, Madrid, Spain; 2Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ, Madrid, Spain Abstract: Severe asthma constitutes illness in a relatively small proportion of all patients with asthma, but it is a major public health problem – with considerable effect on morbidity, mortality, as well as a high burden on health care resources. Regardless of effective treatments being widely available and the existence of treatment guidelines, a large population of severe asthma cases remain uncontrolled. Achieving and maintaining asthma control in this group of patients is, therefore, of utmost importance. The recognition of distinct inflammatory phenotypes within this population has driven the development of targeted biological therapies – particularly, selective targeted monoclonal antibodies (mAbs. It is noteworthy that in approximately 50% of these patients, there is strong evidence of the pathogenic role of T helper type-2 (Th2 cytokines, such as interleukin (IL-4 and IL-13, orchestrating the eosinophilic and allergic inflammatory processes. Among the recently developed antiasthma biologic drugs, the mAb dupilumab is very promising given its ability to inhibit the biological effects of both IL-4 and IL-13. In this review, we focused on IL-4 and IL-13, as these interleukins are considered to play a key role in the pathophysiology of asthma, and on dupilumab, an anti-IL-4 receptor human mAb, as a forthcoming treatment for uncontrolled severe asthma in the near future. Keywords: dupilumab, asthma, interleukin-4, interleukin-13, monoclonal antibodies, treatment
Shields, Michael D.; Heaney, Liam G.; Kendall, Marilyn; Pearce, Christina J.; Hui, Chi Yan; Pinnock, Hilary
Introduction Financial incentives are utilised in healthcare systems in a number of countries to improve quality of care delivered to patients by rewarding practices or practitioners for achieving set targets. Objectives To systematically review the evidence investigating the impact of financial incentives for implementation of supported self-management on quality of care including: organisational process outcomes, individual behavioural outcomes, and health outcomes for individuals with asthma or diabetes; both conditions with an extensive evidence base for self-management. Methods We followed Cochrane methodology, using a PICOS search strategy to search eight databases in November 2015 (updated May 2017) including a broad range of implementation methodologies. Studies were weighted by robustness of methodology, number of participants and the quality score. We used narrative synthesis due to heterogeneity of studies. Results We identified 2,541 articles; 12 met our inclusion criteria. The articles were from the US (n = 7), UK (n = 4) and Canada (n = 1). Measured outcomes were HbA1c tests undertaken and/or the level achieved (n = 10), written action plans for asthma (n = 1) and hospital/emergency department visits (n = 1). Three of the studies were part of a larger incentive scheme including many conditions; one focused on asthma; eight focussed on diabetes. In asthma, the proportion receiving ‘perfect care’ (including providing a written action plan) increased from 4% to 88% in one study, and there were fewer hospitalisations/emergency department visits in another study. Across the diabetes studies, quality-of-care/GP performance scores improved in three, were unchanged in six and deteriorated in one. Conclusions Results for the impact of financial incentives for the implementation of self-management were mixed. The evidence in diabetes suggests no consistent impact on diabetic control. There was evidence from a single study of improved process and health
Stillwell, W.; Seaver, D.; Keller, J.; Smith, D.; Weaver, D.; Sanders, T.; Thullen, P.
An overall approach to risk management is described in this paper. Many of these concepts have been developed and applied as part of Hanford Mission Planning (HMP) (Hanford Mission Plan, 1992). At Hanford, HMP provides a mechanism for integrating planning across all the missions and programs of the site. This paper discusses the decision context within which EM must make and defend decisions, the types of decisions that are being and will need to be made in order to progress with the cleanup of the DOE complex, and the resulting need for risk management. Risk management, in turn, requires quality health and ecological risk information to make these decisions. Other types of information are also needed, but the risk information is typically the most important and the most difficult to obtain. The paper then describes a general technical approach to risk management, including particular methods for developing the high quality of human health and ecological risk information that will be needed to support risk management. We next turn to several special issues that make risk management more complex than many other decisions. We discuss these issues and offer some practical suggestions with respect to addressing them in the risk management framework. Finally, we conclude with some discussion of other opportunities for applying risk management
Donner, Claudio F; Visconti, Alberto
The management of patients with complex forms of bronchial asthma and COPD is not usually addressed in the major international guidelines and management documents which exclusively address pure forms. AIMAR thus undertook a survey to obtain information about: a) the perceived frequency of complex forms of asthma/COPD in adult patients and in the elderly; b) patient management regarding the complex forms (focus on therapeutic goals and consequent treatment); c) the management problems perceived in diagnosis, management, monitoring, indices of appropriateness in pharmacological treatment and adherence to treatment. The survey consisted of 18 multiple choice questions, completed by means of a web-based electronic form published in internet. All the data and responses inserted in the system were checked on-line for coherence and completeness directly during the phase of insertion and each participant had one only possibility of participating. The data thus collected were memorized directly within a relational database, based on consolidated open-source MySQL technology, and thus were immediately available for examination also during the course of the survey. Access to the data, mediated by a "back office" system of interrogation and report, enabled constant monitoring of the survey as it was being carried out, as well as extractions and verification, even on smaller data sets. The survey was carried out in the full month of December 2013 and first half of January 2014. A total of 252 questionnaires were collected from the following physician groups: pneumologists (n = 180), general practitioners (GPs) (n = 32), allergologists (n = 8), internal medicine specialists (n = 20), other specialists (n = 12). Complex forms of bronchial asthma and COPD are frequently observed and considered present in variable percentages ranging from about 10% to about 50% of patients visited and considered typical of patients with a previous history of asthma. Risk factors
The goal of asthma management is to achieve disease control. Poorly controlled asthma is associated with an increased number of days lost from school, exacerbations and days in hospital. Furthermore, children with uncontrolled asthma have more frequent contacts with the health-care system. Recent...... studies have added new information about the effects of poorly controlled asthma on a range of important, but less studied outcomes, including risk of obesity, daily physical activity, cardiovascular fitness, stress, concentration and focused attention, learning disabilities and risk of depression. From...... these studies it seems that poor asthma control may have a greater impact on the child than previously thought. This may have important long-term consequences for the child such as an increased risk of life-style associated diseases and poorer school performance. The level of control seems to be the most...
Since I wrote the Foreword for the second edition of this book, risk management processes have become much more widely used, but controversy about what should be done and how best to do it has grown. Managing risk is a risky business. Chapman and Ward provide an in-depth explanation of why it is important to understand and manage underlying uncertainty in all its forms, in order to realise opportunities more fully and enhance corporate performance. They show what best practice should look like. The implications go well beyond the conventional wisdom of project risk management, providing an enl
US Environmental Protection Agency, 2010
Asthma has reached epidemic proportions in the United States, affecting millions of people of all ages and races. An average of one out of every 10 school-age children now has asthma, and the percentage of children with asthma is rising more rapidly in preschool-age children than in any other age group. Asthma is a leading cause of school…
Full Text Available A questionnaire on the treatment of asthma was sent to 586 physicians. They consisted of specialists authorized by the Japanese Society of Allergology and councillors of the society who were treating patients with bronchial asthma. Of the total of 306 (52% respondents, 241 replied to questions relating to adult asthma and 129 to questions relating to childhood asthma (including duplicate replies. For acute treatment, methods most commonly selected by physicians were, in increasing order of popularity, for adults: parenteral aminophylline, oxygen inhalation, parenteral steroids and parenteral adrenaline; for schoolchildren (6–16 years: parenteral aminophylline, inhaled β-stimulant, oxygen inhalation, inhaled β-stimulant + disodium cromoglycate (DSCG, parenteral steroids; and for infants (≤5 years: inhaled β-stimulant, parenteral aminophylline, oxygen inhalation, inhaled β-stimulant + DSCG and parenteral steroids. For maintenance treatment, methods most commonly selected by physicians were, in increasing order of popularity, for adults: oral administration of sustained-release theophylline, inhaled steroids and DSCG inhalation; for schoolchildren (6–16 years: DSCG inhalation, oral administration of sustained-release theophylline, oral administration of antiallergic agent preparation and (β-stimulant + DSCG inhalant; and for infants: DSCG inhalation, oral administration of sustained-release theophylline, oral administration of antiallergicagent preparation and β-stimulant + DSCG inhalant. The questionnaire results clearly showed that different drugs were selected for the treatment of asthma in adults, schoolchildren and infants.
[Ambulatory care of patients with asthma in Germany and disease management program for asthma from the view of statutory health insured patients. A postal survey of statutory health insured patients].
Bücker, B; Löscher, S; Schürer, C; Schaper, K; Abholz, H-H; Wilm, S
In spite of a decline in mortality due to asthma in Germany various studies point towards deficits in asthma care. Our investigation should collect data about ambulatory care from the view of statutory health insured patients (SHI), who participate in the disease management program asthma (DMP-P) or do not (NP). Primary question was, if there is a difference between asthma control. Secondary questions referred to process parameters. The postal inquiry was conducted in 2010 with 8000 randomly selected members of a SHI company with asthma (4000 DMP-P and 4000 NP). The descriptive evaluation of categorical items was performed with cross-tables. The absolute risk reduction (ARR) and 97.5 %-confidence interval (CI; multiple level 5 %) was used to evaluate the primary question. Secondary questions were analysed by ARR and 95 %-CI. The response rate of the questionnaire accounted for 31.1 % (2565). 49.2 % of all respondents lived with an uncontrolled asthma with no differences between DMP-P and NP (ARR -2.7 %, 97.5 %-CI -7.9 -2.4 %). Results did not alter after adjustment for sex and age. The secondary questions revealed significant differences (DMP-P vs. NP) in participation in asthma trainings 50.6 vs. 32.3 %, use of a peak-flow-meter 49.3 vs. 25.3 % and asthma action plan within reach 21.7 vs. 11.0 %. Half of all respondents lives selfreported - even in the DMP-group - with an uncontrolled asthma. Process parameters showed better results in the DMP-group. It can be considered, that the DMP has its desired effect on patient-centered care, but does not lead to a better therapeutic outcome. Explanations can only be assumed: insufficient impact of the process parameters on the outcome, patient behavior, that minimizes a possible effect, or selection effects, if patients, who were more sick and at the same time more motivated, were mainly included in the DMP. These aspects should be addressed in studies with a prospective design. © Georg Thieme
There are approximately 6,300 people in Ireland with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) and with a fast growing elderly population the incidence of COPD is likely to increase. This study examines the prescribing patterns of medicines dispensed for the management Asthma\\/COPD in patients over the age of 35 years using the HSE-Primary Care Reimbursement Services (PCRS) prescribing databases. The HSE-PCRS pharmacy claims data, which covers all those over 70 years of age and means tested for those less than 70 years, was analysed for the years 2005\\/2006. Approximately 26,548 (17.9%) of patients who were prescribed a respiratory drug received inhaled short-acting beta2 agonists in combination with a regular standard-dose inhaled corticosteroid. A further 5,044 (3.4%) were also prescribed a regular inhaled long-acting beta2 agonist (salmeterol or formoterol). A total of 2506 patients (6.2%) on combination therapy were co-prescribed four different anti-asthmatic treatments inclusive of oral prednisolone. A small proportion of the patients prescribed a respiratory drug were co-prescribed nicotine replacement therapy (n = 5177, 3.5%). In total there were 9,728 (6.2%) patients prescribed a mucolytic drug in combination with a respiratory drug and the rate of co-prescribing with antibiotics was 22%. COPD is a debilitating disease that is primarily caused by smoking and is therefore largely preventable. The HSE-PCRS pharmacy claims data is a valuable tool for helping to assess the burden of this disease in the Irish context.
Full Text Available Asthma is a rapidly growing chronic disease in the general population of the world, mostly in children. Puerto Ricans have the highest prevalence of children with asthma among the Hispanic community in the US and its territories. Asthma and air quality are becoming a significant and potentially costly public health issue in Puerto Rico. The CDC has reported that in Puerto Rico, 320,350 adults have asthma and this number represents 11.5% of the island adult population. The north east municipality of Carolina, Puerto Rico, has the highest asthma prevalence in the 0 to 17 year old range (2001 data. In this study, we address the potential relationship between anthropogenic and naturally occurring environmental factors, and asthma prevalence in an urban elementary public school in Carolina in an effort to empower and engage communities to work on their environmental health issues. We integrated geographic information systems (GIS data of anthropogenic activities near the school as well as the natural resources and geomorphology of the region. We found that as Carolina is close by to Caribbean National Forest (El Yunque, this together with the temperature and precipitation cycles in the zone creates the ideal environmental conditions for increased humidity and pollen, mold and fungi development through out the year. We also collected health and socio economic data to generate an asthma profile of the students, employees and parents from the school community, and through a survey we identified perceptions on environmental asthma triggers, and indoor air quality in the school and homes of the students and employees. Finally, we implemented a workshop on indoor air quality designed to engage the school community in managing asthma triggers and the school environment. Our results showed that nearly 30 % of its studentÃ¢Â€Â™s population has asthma, and from this group 58% are males and 42% are female students. Of all asthmatic children, only 43
Diep, Judy; Fagnano, Maria; Tremblay, Paul; Halterman, Jill S
Subjective social status (SSS) is a person's perception of his/her social standing among others. We explored the relationship between caregivers' SSS and asthma symptoms, visits, and medication use among children with persistent asthma. We analyzed baseline data of children (3-10 years) from the SB-TEAM trial in Rochester, NY. Using a modified MacArthur Scale of SSS, caregivers rated themselves "a lot worse off" to "a lot better off" compared to 4 groups (e.g., neighbors). "Low SSS" was defined by a response of "a lot worse off" or "somewhat worse off" for any of the referent groups. Caregivers reported their child's asthma symptoms, healthcare visits for asthma, and medication use. Bivariate and multivariate statistics were used. We found that, of the 230 children enrolled (participation rate:78%, 62% Black, 72% Medicaid), 29% of caregivers had low SSS. Caregivers with low SSS had more depressive symptoms (46% vs. 28%) and lower social support (69.1 vs. 77.7). In multivariable analyses, children of caregivers with low SSS had fewer symptom-free days/2 weeks (5.8 vs. 7.9, p = .01). While they were more likely to have a routine asthma visit in the past year (35% vs. 23%, adjusted p = .03), there was no difference in their use of preventive medication. Many caregivers of children with persistent asthma report low SSS. While children of these caregivers had fewer symptom-free days, they were not more likely to use preventive medications. Efforts are needed to support these caregivers to ensure optimal preventive care and reduce morbidity.
Soubra Said; Guntupalli Kalapalatha
Although asthma is a condition that is managed in the outpatient setting in most patients, the poorly controlled and severe cases pose a major challenge to the health-care team. Recognition of the more common insidious and the less common rapid onset "acute asphyxic" asthma are important. The intensivist needs to be familiar with the factors that denote severity of the exacerbation. The management of respiratory failure in asthma, including pharmacologic and mechanical ventilation, are discus...
Darlington, Joanne D
For the past several years, as the profession of emergency management has been evolving, there has been a growing interest in the need for more formalized training for the nation s hazards and emergency managers...
Full Text Available Background: Advanced information systems have changed the way managers work with planning and performance measurement. Traditional management control concepts such as efficiency have changed in meaning due to these information systems.
Juan Manuel San Martín Reyna
Full Text Available This paper analyses the influence of ownership structure, board and leverage on the earnings management when companies either face, or do not face, profitable growth opportunities for a sample of 90 listed Mexican firms during the period 2005-2009. The results confirm the relevance of debt and board of directors in terms of earnings management by showing a positive relationship between earnings management and both board of directors and leverage in the presence of growth opportunities. In contrast, this relationship becomes negative when firms have no profitable investment projects. The results also demonstrate the relevance of controlling shareholders on earnings management under a growth opportunity setting.Therefore, our results show that ownership structure, composition and size of board and leverage play a dual role: reduce the earnings management when there are no investments projects, but impact positively in presence of growth opportunities.
Zhong, Connie S.; Melendez-Torres, G. J.
Background: Adolescents with asthma face unique challenges due to hormonal changes, psychosocial development and healthcare transition. Peer-led self-management programmes may increase treatment adherence and social adjustment by addressing these challenges. The purpose of this study was to assess whether peer-led self-management programmes…
Morrow, Susan; Daines, Luke; Wiener-Ogilvie, Sharon; Steed, Liz; McKee, Lorna; Caress, Ann-Louise; Taylor, Stephanie J C; Pinnock, Hilary
Despite an overwhelming evidence base, supported self-management of asthma is poorly implemented into routine practice. Strategies for implementation must address organisational routines, as well as provide resources for patients and training to improve professionals' skills. We aimed to explore the priority that primary care practices attach to asthma self-management, to describe their existing asthma management routines, and to generate innovative implementation strategies. We recruited 33 participants (23 general practitioners; seven nurses; three administrative staff) from 14 general practices. The 12 interviews and three focus groups were transcribed, coded and analysed thematically. Supported self-management was largely a nurse-led task within clinic-based annual reviews. Barriers included poor attendance at asthma clinics, lack of time, demarcation of roles, limited access to a range of tailored resources, and competing agendas in consultation, often due to multimorbidity. Suggestions for initiatives to improve the provision of supported self-management included emphasising the evidence for benefit (to influence prioritisation), improving teamwork (including team-based education), organisational strategies (including remote consulting) which need to fit within existing practice routines. Technology offers some potential solutions (e.g., improved templates, 'app'-based plans), but must be integrated with the practice information technology systems. Building on these insights, we will now develop a theoretically-based implementation strategy that will address patient, professional, and organisational buy-in, provide team-based education and offer a range of practical options and tools, which can be adapted and integrated within existing routines of individual practices.OVERCOMING THE ORGANISATIONAL BARRIERS TO IMPLEMENTING ASTHMA SELF-MANAGEMENT: Understanding the routines of primary care practices can suggest strategies to implement supported self-management
... in the airways of the lungs. When an asthma attack occurs, the lining of the air passages swells ... small amount of the substance can trigger an asthma attack. Using a respiratory device to protect or reduce ...
EPA is working to explore the role of common air pollutants in the development and exacerbation of asthma at different life stages as well as other environmental and genetic factors that might make a person more sensitive to developing asthma.
Le Moual, Nicole; Kauffmann, Francine; Eisen, Ellen A; Kennedy, Susan M
Despite the increasing attention to the relationship between asthma and work exposures, occupational asthma remains underrecognized and its population burden underestimated. This may be due, in part, to the fact that traditional approaches to studying asthma in populations cannot adequately take into account the healthy worker effect (HWE). The HWE is the potential bias caused by the phenomenon that sicker individuals may choose work environments in which exposures are low; they may be excluded from being hired; or once hired, they may seek transfer to less exposed jobs or leave work. This article demonstrates that population- and workplace-based asthma studies are particularly subject to HWE bias, which leads to underestimates of relative risks. Our objective is to describe the HWE as it relates to asthma research, and to discuss the significance of taking HWE bias into account in designing and interpreting asthma studies. We also discuss the importance of understanding HWE bias for public health practitioners and for clinicians. Finally, we emphasize the timeliness of this review in light of the many longitudinal "child to young adult" asthma cohort studies currently underway. These prospective studies will soon provide an ideal opportunity to examine the impact of early workplace environments on asthma in young adults. We urge occupational and childhood asthma epidemiologists collaborate to ensure that this opportunity is not lost.
Statement by a working group of the South African Pulmonology Society. The morbidity and mortality caused by asthma can be attributed to three factors: underassessment of severity, failure on the part of both patients and their medical attendants to initiate treatment promptly, and undertreatment of exacerbations; Moreover ...
Conclusion: The positive outcome in controlling acute episodes of asthma, reducing the frequency and intensity of subsequent episodes and weaning of bronchodilators and other allopathic drugs have been reported. As only observational studies have been conducted, further pragmatic trials including randomized control studies are desirable.
This thesis discusses the role of a specialized nurse practitioner in the follow up of children with asthma in comparison with traditional care by a general practitioner or a paediatrician. In addition, we evaluated the suitability of an existing questionnaire to assess quality of care and we
Gordon, Erin; Lazarus, Stephen C
For many years, chronic obstructive pulmonary disease (COPD) was considered a disease of fixed airflow obstruction for which there was no good treatment. Out of desperation and frustration, health care providers extrapolated from asthma to COPD, and standard asthma therapy was adopted without evidence for efficacy. In recent years, we have gained a better understanding of the pathophysiologic differences between asthma and COPD, and prospective controlled trials have provided a rationale for therapy. Smoking cessation is critically important, both as primary prevention and as an effective way to slow the decrease in lung function in patients with established disease. beta(2)-Adrenergic and anticholinergic agonists improve lung function and relieve symptoms in most patients. Tiotropium improves exercise tolerance and quality of life and reduces exacerbations and hospitalizations. The increase in lung function seen with tiotropium is sustained with continued use over at least 3 to 4 years. Inhaled corticosteroids decrease exacerbations and improve quality of life, and their effect seems greatest in patients with lower lung function and in exacerbation-prone patients. There is no evidence that inhaled corticosteroids alone affect mortality, despite the reduction in exacerbations and increased risk of pneumonia. In some patient populations, inhaled fluticasone, salmeterol, or the combination might slow the rate of loss of lung function. Rather than reflexively using effective asthma therapy in the patient with COPD, current and future therapy for COPD is increasingly evidence based and targeted to specific inflammatory pathways that are important in patients with COPD.
David Van Sickle
Full Text Available OBJECTIVE: Adequate symptom control is a problem for many people with asthma. We asked whether weekly email reports on monitored use of inhaled, short-acting bronchodilators might improve scores on composite asthma-control measures. METHODS: Through an investigational electronic medication sensor attached to each participant's inhaler, we monitored 4 months' use of inhaled, short-acting bronchodilators. Participants completed surveys, including the Asthma Control Test(TM (ACT, to assess asthma control at entry and monthly thereafter. After the first month, participants received weekly email reports for 3 months. The reports summarized inhaled bronchodilator use during the preceding week and provided suggestions derived from National Asthma Education and Prevention Program (NAEPP guidelines. Paired t-tests and random-effects mixed models were implemented to assess changes in primary asthma endpoints. RESULTS: Thirty individuals participated in the 4-month study; 29 provided complete asthma control information. Mean age was 36.8 years (range: 19-74 years; 52% of respondents were female. Mean ACT scores were 17.6 (Standard Deviation [SD] = 3.35 at entry and 18.4 (SD = 3.60 at completion of the first month. No significant difference appeared between ACT values at entry and completion of the first month (p = 0.66; however, after participants began receiving email reports and online information about their inhaler use, mean ACT scores increased 1.40 points (95% CI: 0.61, 2.18 for each subsequent study month. Significant decreases occurred in 2-week histories of daytime symptoms (β = -1.35, 95% CI: -2.65, -0.04 and nighttime symptoms (β = -0.84, 95% CI: -1.25, -0.44; no significant change in activity limitation (β = -0.21, 95% CI: -0.69, 0.26 was observed. Participants reported increased awareness and understanding of asthma patterns, level of control, bronchodilator use (timing, location and triggers, and improved
Farzandipour, Mehrdad; Nabovati, Ehsan; Sharif, Reihane; Arani, Marzieh Heidarzadeh; Anvari, Shima
Objective The aim of this systematic review was to summarize the evidence regarding the effects of mobile health applications (mHealth apps) for self-management outcomes in patients with asthma and to assess the functionalities of effective interventions. Methods We systematically searched Medline, Scopus, and the Cochrane Central Register of Controlled Trials. We included English-language studies that evaluated the effects of smartphone or tablet computer apps on self-management outcomes in asthmatic patients. The characteristics of these studies, effects of interventions, and features of mHealth apps were extracted. Results A total of 10 studies met all the inclusion criteria. Outcomes that were assessed in the included studies were categorized into three groups (clinical, patient-reported, and economic). mHealth apps improved asthma control (five studies) and lung function (two studies) from the clinical outcomes. From the patient-reported outcomes, quality of life (three studies) was statistically significantly improved, while there was no significant impact on self-efficacy scores (two studies). Effects on economic outcomes were equivocal, so that the number of visits (in two studies) and admission and hospitalization-relevant outcomes (in one study) statistically significantly improved; and in four other studies, these outcomes did not improve significantly. mHealth apps features were categorized into seven categories (inform, instruct, record, display, guide, remind/alert, and communicate). Eight of the 10 mHealth apps included more than one functionality. Nearly all interventions had the functionality of recording user-entered data and half of them had the functionality of providing educational information and reminders to patients. Conclusion Multifunctional mHealth apps have good potential in the control of asthma and in improving the quality of life in such patients compared with traditional interventions. Further studies are needed to identify
Full Text Available Asthma is a chronic disorder affecting millions of people worldwide. The prevalence of asthma is around 300 million and is expected to increase another 100 million by 2025. Obesity, on the other hand, also affects a large number of individuals. Overweight in adults is defined when body mass index (BMI is between 25 to 30 kg/m 2 and obesity when the BMI >30 kg/m 2 . It has been a matter of interest for researchers to find a relation between these two conditions. This knowledge will provide a new insight into the management of both conditions. At present, obese asthma patients may be considered a special category and it is important to assess the impact of management of obesity on asthma symptoms.
Rusnak, James E.
Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The hospital must insure the CMMS project provides a means to implement an integrated on-line hospital information data base for use by departments in operating under a DRG-based Prospective Payment System. This paper presents guidelines for use in selecting a Case Mix Mangement System to meet the hospital's financial and operations planning, budgeting, marketing, and other management needs, while considering the data base implications of the implementation.
Chris B. LeDoux
Forest landowners, managers, loggers, land-use planners, and other decision/policy makers need to understand the opportunity cost associated with different levels of allowable management and required/voluntary protection in streamside management zones (SMZs). Four different logging technologies, two mature hardwood stands, three levels of streamside zone protection,...
Sabatelli, L; Seppälä, U; Sastre, J; Crater, G
Fractional exhaled nitric oxide (FeNO) is a marker for type 2 airway inflammation. The objective of this study was to evaluate the cost-effectiveness and budget impact of FeNO monitoring for management of adult asthma in Spain. A cost-effectiveness analysis model was used to evaluate the effect on costs of adding FeNO monitoring to asthma management. Over a 1-year period, the model estimated the incremental cost per quality-adjusted life year and incremental number of exacerbations avoided when FeNO monitoring was added to standard guideline-driven asthma care compared with standard care alone. Univariate and multivariate sensitivity analyses were applied to explore uncertainty in the model. A budget impact model was used to examine the impact of FeNO monitoring on primary care costs across the Spanish health system. The results showed that adding FeNO to standard asthma care saved €62.53 per patient-year in the adult population and improved quality-adjusted life years by 0.026 per patient-year. The budget impact analysis revealed a potential net yearly saving of €129 million if FeNO monitoring had been used in primary care settings in Spain. The present economic model shows that adding FeNO to the treatment algorithm can considerably reduce costs and improve quality of life when used to manage asthma in combination with current treatment guidelines.
Electronic records of government organizations are becoming increasingly important for accountability. Managing electronic records, however, proves to be difficult since information and communication technologies confront organizations with various opportunities and risks. In this paper the findings
Breen, Charlotte; Farragher, Ailish; McQuaid, Mairead; Callanan, Michelle; Burke, Mary A.
Evaluates the gap between traditional library and information studies (LIS) skills and the evolving needs of the information technology workplace. Discusses whether graduates with LIS training are perceived as having the requisite skills and personalities to perform as knowledge managers and information managers in the private sector based on…
Yang, Wenya; Dall, Timothy M; Zhang, Yiduo; Hogan, Paul F; Arday, David R; Gantt, Cynthia J
To assess the effect of TRICARE's asthma, congestive heart failure, and diabetes disease management programs using a scorecard approach. EVALUATION MEASURES: Patient healthcare utilization, financial, clinical, and humanistic outcomes. Absolute measures were translated into effect size and incorporated into a scorecard. Actual outcomes for program participants were compared with outcomes predicted in the absence of disease management. The predictive equations were established from regression models based on historical control groups (n = 39,217). Z scores were calculated for the humanistic measures obtained through a mailed survey. Administrative records containing medical claims, patient demographics and characteristics, and program participation status were linked using an encrypted patient identifier (n = 57,489). The study time frame is 1 year prior to program inception through 2 years afterward (October 2005-September 2008). A historical control group was identified with the baseline year starting October 2003 and a 1-year follow-up period starting October 2004. A survey was administered to a subset of participants 6 months after baseline assessment (39% response rate). Within the observation window--24 months for asthma and congestive heart failure, and 15 months for the diabetes program--we observed modest reductions in hospital days and healthcare cost for all 3 programs and reductions in emergency visits for 2 programs. Most clinical outcomes moved in the direction anticipated. The scorecard provided a useful tool to track performance of 3 regional contractors for each of 3 diseases and over time.
Ph. d.PROFESSOR iORDACHE PLAT
Full Text Available Equal opportunity is a relatively new concept which first of all must be understood, and then implemented as a premise and note as a result of current activities. Equal opportunity in organizations is a new way of achieving results and the modern management puts it as a necessary principle among old ones, such as benchmarking, corporate governance, customer relatioship marketing, experience curve, strategies alliances etc. This paper explains the equal opportunity in higher education institutions, their improvements and dilemma sin implementing equal opportunities.
State Departments of Transportation and other transportation agencies collect vast quantities of data but managing, accessing and sharing data has been problematic and well documented. This project reviewed the similar challenges faced by other indus...
Pagh, Janus Dóre; Cooper, Martha
This paper concentrates on operationalizing the supply chain management framework suggested in a 1997 article. Case studies conducted at several companies and involving multiple members of supply chains are used to illustrate the concepts described...
Master's thesis in for Offshore Technology: Industrial Asset Management The purpose of the report is to highlight methods that can make it easier for the construction industry and industry in general to benefit from new technology. The report is intended as a reference to technological solutions that along with some techniques, can streamline workflow for multiple tasks in planning, design, and operation and maintenance management. The problems focused on is how to: • Simplify the procu...
Knoeller, Gretchen E; Mazurek, Jacek M; Moorman, Jeanne E
Proper asthma management and control depend on patients having affordable access to healthcare yet financial barriers to asthma care are common. To examine associations of work-related asthma (WRA) with financial barriers to asthma care and adverse asthma outcomes. Cross-sectional, random-digit-dial survey conducted in 37 states and District of Columbia. A total of 27,927 ever-employed adults aged ≥18 years with current asthma. Prevalence ratios (PR) for the associations of WRA with financial barriers to asthma care and of WRA with adverse asthma outcomes stratified by financial barriers. Persons with WRA were significantly more likely than those with non-WRA to have at least 1 financial barrier to asthma care [PR, 1.66; 95% confidence interval (CI), 1.43-1.92]. Individuals with WRA were more likely to experience adverse asthma outcomes such as asthma attack (PR, 1.31; 95% CI, 1.22-1.40), urgent treatment for worsening asthma (PR, 1.57; 95% CI, 1.39-1.78), asthma-related emergency room visit (PR, 1.69; 95% CI, 1.41-2.03), and very poorly controlled asthma (PR, 1.54; 95% CI: 1.36-1.75). After stratifying for financial barriers to asthma care, the associations did not change. Financial barriers to asthma care should be considered in asthma management, and individuals with WRA are more likely to experience financial barriers. However, individuals with WRA are more likely to experience adverse asthma outcomes than individuals with non-WRA, regardless of financial barriers. Additional studies are needed to identify medical, behavioral, occupational, or environmental factors associated with adverse asthma outcomes among individuals with WRA.
Full Text Available Idiopathic nontransplant-related childhood bronchiolitis obliterans is an uncommon disease. Most patients present with chronic recurrent dyspnea, cough and wheezing, which are also features of asthma, by far a much more common condition. The present case study reports on a six-year-old girl who presented to a tertiary care centre with recurrent episodes of respiratory distress on a background of baseline tachypnea, chronic hypoxemia and exertional dyspnea. Her past medical history revealed significant lung disease in infancy, including respiratory syncytial virus bronchiolitis and repaired gastroesophageal reflux. She was treated for 'asthma exacerbations' throughout her early childhood years. Bronchiolitis obliterans was subsequently diagnosed with an open lung biopsy. She did not have sustained improvement with systemic corticosteroids, hydroxychloroquine or clarithromycin. Cardiac catheterization confirmed the presence of secondary pulmonary hypertension. Treatment options remain a dilemma for this patient because there is no known effective treatment for this condition, and the natural history is not well understood. The present case demonstrates the need for careful workup in 'atypical asthma', and the urgent need for further research into the rare lung diseases of childhood.
Gustafson, David; Wise, Meg; Bhattacharya, Abhik; Pulvermacher, Alice; Shanovich, Kathleen; Phillips, Brenda; Lehman, Erik; Chinchilli, Vernon; Hawkins, Robert; Kim, Jee-Seon
Asthma is the most common pediatric illness in the United States, burdening low-income and minority families disproportionately and contributing to high health care costs. Clinic-based asthma education and telephone case management have had mixed results on asthma control, as have eHealth programs and online games. To test the effects of (1) CHESS+CM, a system for parents and children ages 4-12 years with poorly controlled asthma, on asthma control and medication adherence, and (2) competence, self-efficacy, and social support as mediators. CHESS+CM included a fully automated eHealth component (Comprehensive Health Enhancement Support System [CHESS]) plus monthly nurse case management (CM) via phone. CHESS, based on self-determination theory, was designed to improve competence, social support, and intrinsic motivation of parents and children. We identified eligible parent-child dyads from files of managed care organizations in Madison and Milwaukee, Wisconsin, USA, sent them recruitment letters, and randomly assigned them (unblinded) to a control group of treatment as usual plus asthma information or to CHESS+CM. Asthma control was measured by the Asthma Control Questionnaire (ACQ) and self-reported symptom-free days. Medication adherence was a composite of pharmacy refill data and medication taking. Social support, information competence, and self-efficacy were self-assessed in questionnaires. All data were collected at 0, 3, 6, 9, and 12 months. Asthma diaries kept during a 3-week run-in period before randomization provided baseline data. Of 305 parent-child dyads enrolled, 301 were randomly assigned, 153 to the control group and 148 to CHESS+CM. Most parents were female (283/301, 94%), African American (150/301, 49.8%), and had a low income as indicated by child's Medicaid status (154/301, 51.2%); 146 (48.5%) were single and 96 of 301 (31.9%) had a high school education or less. Completion rates were 127 of 153 control group dyads (83.0%) and 132 of 148 CHESS
Steinman, Theodore I
The geriatric population with end-stage renal disease (ESRD) is placed at risk with regards to the quality and extent of medical coverage because of the rapidly changing financial environment. Managed care organizations (MCOs) are generally for-profit companies that must focus on the bottom line. While the verbal commitment to quality care is voiced, the financial pressures on MCOs have led to a decrease in coverage of many services and outright denial for some necessary treatments. While denying services, the MCOs have also reduced payments to providers for services rendered. The coverage crisis is compounded by health maintenance organizations (HMOs) quitting Medicare because the reimbursement from the Health Care Financing Administration (HCFA) is less than their costs. Because of the above issues which can potentially impact on the quality of care delivered to the ESRD geriatric population, a new approach to disease management has created the opportunity to improve total patient care to a level not yet achieved in the United States. Disease management encompasses integrated care across all disciplines. Every component of care can be tracked by a dedicated information system. Improvement in outcomes has far exceeded the U.S. Renal Data System (USRDS) benchmark performance measurements with a disease management model approach. The key to success is the health service coordinator (HSC), a senior nurse with many years of ESRD experience. This individual coordinates care across all disciplines and expedites necessary referrals. With rapid attention to patient needs there has been a significant reduction in hospital admissions, hospital length of stay, and emergency room visits. Patient care will steadily improve as the disease management system matures as a consequence of understanding the patients total physical and psychosocial needs.
Garmendia, Jenny V; Moreno, Dolores; Garcia, Alexis H; De Sanctis, Juan B
Metabolic syndrome (MetS) is a syndrome that involves at least three disorders dyslipidemia, insulin resistance, obesity and/or hypertension. MetS has been associated with several chronic diseases in the adulthood; however, in the recent years, the syndrome was redefined in children. Girls with early menarche and asthma, and children with MetS and asthma that reach adulthood appear to have higher risk to develop severe or difficult to control asthma and a higher probability to suffer cardiovascular diseases. It has been proposed that patients with MetS and endocrinological disorders should be considered a different entity in which pharmacologic treatment should be adjusted according to the individual. Recent patents on the field have addressed new issues on how endocrine control should be managed along with asthma therapeutics. In the near future, new approaches should decrease the high morbidity and mortality associated to these types of patients.
The Rehab power plant located in the Northern part of Jordan is presented as a case study of industrial water management. This power plant consumes boiler feed water in the amount of 200 m3/d of the fresh ground water available from nearby wells and it produces 193 m3/d of wastewater. Fifty seven water samples were ...
Mendling, Jan; Weber, Ingo; Van Der Aalst, Wil; Brocke, Jan Vom; Cabanillas, Cristina; Daniel, Florian; Debois, Søren; Di Ciccio, Claudio; Dumas, Marlon; Dustdar, Schahram; Gal, Avigdor; García-Bañuelos, Luciano; Governatori, Guido; Hull, Richard; La Rosa, Marcello; Leopold, Henrik; Leymann, Frank; Recker, Jan; Reichert, Manfred; Reijers, Hajo A.; Rinderlema, Stefanie; Solti, Andreas; Rosemann, Michael; Schulte, Stefan; Singh, Munindar P.; Slaats, Tijs; Staples, Mark; Weber, Barbara; Weidlich, Matthias; Weske, Mathias; Xu, Xiwei; Zhu, Liming
Blockchain technology ofers a sizable promise to rethink the way interorganizational business processes are managed because of its potential to realize execution without a central party serving as a single point of trust (and failure). To stimulate research on this promise and the limits thereof, in
Mendling, J.; Weber, I.; van der Aalst, W.M.P.; vom Brocke, J.; Cabanillas, C.; Daniel, F.; Debois, S.; Di Ciccio, C.; Dumas, M.; Dustdar, S.; Gal, A.; García-Bañuelos, L.; Governatori, G.; Hull, R.; La Rosa, Marcello; Leopold, Henrik; Leymann, Frank; Recker, Jan; Reichert, Manfred; Reijers, H.A.; Rinderlema, Stefanie; Solti, Andreas; Rosemann, Michael; Schulte, Stefan; Singh, Munindar P.; Slaats, T.; Staples, Mark; Weber, Barbara; Weidlich, Matthias; Weske, Mathias; Xu, Xiwei; Zhu, Liming
Blockchain technology ofers a sizable promise to rethink the way interorganizational business processes are managed because of its potential to realize execution without a central party serving as a single point of trust (and failure). To stimulate research on this promise and the limits thereof, in
Abraham, Janice M.; Baird, Robert; Neugebauer, Frank
Enterprise Risk Management (ERM) gained a foothold in higher education during the first decade of the 21st century. College and university governing board members came to their board service with the perspective and experience of having served on corporate boards and in corporate leadership positions where ERM was in active use. Trustees asked…
O'Byrne, Paul M; Pedersen, Søren; Schatz, Michael
The goal of asthma management is to achieve disease control; however, despite the availability of effective and safe medications, for many patients asthma remains uncontrolled. One reason for this is the fear of long-term side effects from the regular use of inhaled corticosteroids (ICSs). Adverse...... effects of poorly controlled asthma (for example, obesity, pneumonia, and risks to the fetus) can be perceived as side effects of ICSs. Poorly controlled asthma adversely affects children's cardiovascular fitness, while children with well-controlled asthma perform at the same level as their peers....... Children with uncontrolled asthma also have a higher frequency of obesity than children with controlled asthma. Stress can affect asthma control, and children with poorly controlled asthma are more likely to have learning disabilities compared with those with good control. In adults, focused attention...
Gold, Diane R; Adamkiewicz, Gary; Arshad, Syed Hasan; Celedón, Juan C; Chapman, Martin D; Chew, Ginger L; Cook, Donald N; Custovic, Adnan; Gehring, Ulrike; Gern, James E; Johnson, Christine C; Kennedy, Suzanne; Koutrakis, Petros; Leaderer, Brian; Mitchell, Herman E; Litonjua, Augusto A; Mueller, Geoffrey A; O'Connor, George T; Ownby, Dennis; Phipatanakul, Wanda; Persky, Victoria; Perzanowski, Matthew S; Ramsey, Clare D; Salo, Päivi M; Schwaninger, Julie M; Sordillo, Joanne E; Spira, Avrum; Suglia, Shakira F; Togias, Alkis; Zeldin, Darryl C; Matsui, Elizabeth C
Environmental exposures have been recognized as critical in the initiation and exacerbation of asthma, one of the most common chronic childhood diseases. The National Institute of Allergy and Infectious Diseases; National Institute of Environmental Health Sciences; National Heart, Lung, and Blood
INGEROP is working since years on the French Deep Geological Repository's design for Andra, carrying out since 2012 the preliminary design, the global project management and the technical integration for the engineering of the Cigeo project (in a 50-50 consortium with the French company TECHNIP). The article presents some particular organizational aspects that turned out to be more challenging than foreseen in the course of our activities. Starting from the presentation of real examples, some lessons learned are derived as well as practices of interest in solving analogue issues in similar projects, with focus on its application to the management of engineering phase of geological repositories and other 'megaprojects' in different countries. (author)
Asaria, M.; Dhami, S.; van Ree, R.; Gerth van Wijk, R.; Muraro, A.; Roberts, G.; Sheikh, A.
Background: The European Academy of Allergy and Clinical Immunology (EAACI) is developing guidelines for allergen immunotherapy (AIT) for the management of allergic rhinitis, allergic asthma, IgE-mediated food allergy and venom allergy. To inform the development of clinical recommendations, we
This self-instructional unit for supervisors and managers in the British hotel and catering industry is based on the view that problems in staff recruitment and retention are directly linked to the level of job satisfaction. The document begins with an introduction and advice on how to use the unit. Five sections cover the following topics: (1)…
... Asthma Associated Conditions Asthma & Pregnancy Asthma & Pregnancy: Medications Asthma & Pregnancy: Medications Make an Appointment Refer a Patient ... make sure you are using it correctly. Other Asthma Related Medication Treatment Annual influenza vaccine (flu shot) ...
Hollenbach, Jessica P; Cushing, Anna; Melvin, Emilie; McGowan, Bryanna; Cloutier, Michelle M; Manice, Melissa
Mobile technology for childhood asthma can provide real-time data to enhance care. What real-time adherence information clinicians want, how they may use it, and if the data meet their clinical needs have not been fully explored. Our goal was to determine whether pediatric primary care and pulmonary clinicians believe if a sensor-based mobile intervention is useful in caring for patients with asthma. We recruited participants from 3 urban, primary care and 1 pulmonary practice from July to September 2015 in Hartford, CT. Forty-one participated in four focus groups, which included a demonstration of the technology. Participants were probed with open-ended questions on the type, frequency, and format of inter-visit patient information they found useful. 41 participants (mean age 49 (±13.7) years) were board-certified clinicians (41% MDs and 20% mid-level practitioners), practiced medicine on an average of 19 (±14) years, were primarily white (59%) and women (78%). Clinicians wanted 1) adherence to prescribed inhaler therapy and 2) data on inhaler technique. Clinicians wanted it at the time of a scheduled clinic visit but also wanted inter-visit alerts for excessive use of rescue therapy. Pulmonologists liked the mobile spirometer's provision of inter-visit lung function data; pediatricians did not share this view. Concerns with data accuracy were raised due to families who shared inhalers, access to smartphones, and protection of health information. Overall, clinicians view an asthma mobile health technology as enhancing the patient-centered medical home. Pediatric primary care clinicians and pulmonologists want different information from a mobile app.
Isik, Elif; Isik, Ismet S
Asthma is a common chronic disease in children. Uncontrolled asthma is a significant contributor to school absenteeism, emergency room visits, and hospitalization, all of which can lead to low school performance, financial burdens, and emotional problems for children and their parents. Asthma in children restricts the activities of school-aged children, such as participating in before- and after-school activity and extracurricular activities such as sports. Uncontrolled asthma has the potential to impact a student's self-confidence and social interactions. This article reviews the physical, emotional, and social burden of asthma on school-aged children/parents as well as recounting school asthma intervention programs. One of the roles of the school nurse is to be the leader of the intervention programs, manage asthma, and provide education for the students, parents, and school community to promote knowledge about asthma and its management.
Baumber, Alex; Metternicht, Graciela; Ampt, Peter; Cross, Rebecca; Berry, Emily
Cross-property cooperation has the potential to enhance the effectiveness of environmental management actions that cut across property boundaries. Online tools can facilitate this and overcome barriers to landholder engagement in collaborative management. However, collaborative online tools need to be designed and tailored to users' needs and values, and landholder participation in the development process is critical to ensuring uptake and long-term use. This article presents a case study from the Central Tablelands region of New South Wales, Australia, where landholders have been involved in participatory development of a new online collaboration tool. The case study results highlight the significance of issues such as internet access, privacy, technical proficiency and differing stakeholder objectives. A landholder survey identified mapping and the uploading of monitoring data as important functions for the online tool, but these were not rated as highly as functions relating to data security, sharing settings and key term searches. Consequently, we recommend that a future online collaboration tool for the region is not framed specifically as a mapping or citizen science tool, but rather as an adaptive collaboration and communication tool that can incorporate a variety of data types and formats and be modified over time in line with changing landholder needs. Copyright © 2018 Elsevier Ltd. All rights reserved.
Asthma has grown to epidemic proportions among school-age children, and nearly 10 million U.S. adults suffer from it. This paper describes asthma and its triggers and explains how to take measures to manage asthma symptoms within the school (e.g., dusting regularly and keeping medications available). A sidebar presents tips on controlling asthma…
Full Text Available BACKGROUND: Several sets of Canadian guidelines for the diagnosis and management of asthma have been published over the past 15 years. Since the last revision of the 1999 Canadian Asthma Consensus Report, important new studies have highlighted the need to incorporate new information into the asthma guidelines.
Ion Plumb; Andreea Zamfir
The knowledge-based economy, along with the impact of information society technologies, presents the service organizations and their customers with many potential opportunities as well as challenges. Therefore, this study explores how the knowledge-based economy could influence the quality management of service organizations. The study reveals that the actors within the service sector have vast new opportunities in terms of communication and value co-creation, but in the same time, the requir...
This chapter attempts to provide some perspectives on the steps involved in analyzing, evaluating, and implementing remedies for transients and for potentially severe events. The importance of improved response and control of plant transients is stressed. The main steps involved in the attainment of improved control of plant transients are listed. Topics considered include the acquisition of plant data, sensitivity and risk analysis, the options for improvements, the managerial role, and some priorities for data, analysis, and evaluation. The ten most frequent types of transients for pressurized water reactors (PWRs) and boiling water reactors (BWRs) are listed according to frequency of occurrence. It is concluded that the two main needs of transient management are to avoid preoccupation with end-of-spectrum accidents and to improve the rate of technology transfer from best-available analysis and implementation
Full Text Available The purpose of this research is to analyze, design, and implement Master Data Management (MDM model for company, which include database processing that will be used in the quality of data customer and produce single view of customer. The research method used is literature study from a variety of journals, books, e-books, and articles on the internet. Also, fact finding techniques are done, such as by analyze, collect, and examine the documents, interviews, and observations. Then, other research methods used to analyze and design MDM model are using cleansing and matching technique. The result obtained from this research is animplementation MDM model for the company, where if implemented, will improve the quality of data significantly. The conclusion which can be obtained from this research is that MDM is one of the factors thatcan improve the quality of customer data.
Full Text Available Current paper presents studies on the administrative structures in order to optimize the activities and the overall management through the example of the Bulgarian Commission for Protection against Discrimination. It aims at establishing duplicate functions in the organization under study. The main tasks in the analysis are related to the display of the basic findings and conclusions for the strongest sides and the fields for improvement regarding the relevance, the effectiveness and the efficiency of the administration of the Commission for Protection against Discrimination in Bulgaria. The following areas are thoroughly and critically analyzed: relevance of the functions and efficiency of the activity. As a result of the study a Strategy for Organizational Development and a Training Plan have been drafted.
Bousquet, Jean; Bousquet, Philippe J.; Godard, Philippe; Daures, Jean-Pierre
Asthma is a very common chronic disease that occurs in all age groups and is the focus of various clinical and public health interventions. Both morbidity and mortality from asthma are significant. The number of disability-adjusted life years (DALYs) lost due to asthma worldwide is similar to that for diabetes, liver cirrhosis and schizophrenia. Asthma management plans have, however, reduced mortality and severity in countries where they have been applied. Several barriers reduce the availabi...
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Migration, both within and between countries, has increased worldwide in recent years. While migration in itself need not present a risk to health, it is often characterized by increased stress and individual vulnerability to disease and inequalities in access to care.
Migrants from high tuberculosis (TB prevalence countries may be at risk of TB before leaving their country, during travel and after resettlement. In many high-income countries, more than half of the TB cases emerging today occur in patients born in another country. In less affluent countries, shifts in TB epidemiology associated with population movements are also being reported. Foreign-born persons often face several barriers to care in a new country as a result of inadequate knowledge of, or coverage by, the health care services, differences in culture and language, lack of money, comorbidity, concern about discrimination and fear of expulsion. National authorities apply different policies to screen migrants for TB and to provide preventive or curative treatment, with varying coverage, yield and effectiveness.
If screening is to be of use, it needs to fit into a broader national strategy for TB care and management. Appropriate treatment needs to be provided in a manner conducive to its full completion. This is critical both for the individual patient and for public health. We discuss the main associations between TB and migration based on data from recent publications on surveillance, policy and practice.
Full Text Available The management of hospitalized diabetic patients for any cause is often difficult and affected not only by the comorbidities of the patient but also by the hospital setting. It is well known that at the admission the antidiabetic drugs should be discontinued on behalf of insulin therapy with insulin analogues, as a function of a basal-bolus insulin approach according to the phenotype of the patient, type of nutrition (enteral or parenteral rather than oral, or concomitant hyperglycemic therapy (e.g., steroid. The average stay of diabetic patients hospitalized for any cause is significantly correlated with both the number of hypoglycemia and hyperglycemia. Compared to patients treated with sliding scale patients using a custom algorithm show a significant reduction in the number of hypoglycemia and hyperglycemia episodes and in the length of stay. We analyze the clinical profile of a novel basal insulin, degludec, and explore the potential clinical benefit for diabetic inpatient. The continuation of insulin therapy at home in the immediate post-hospitalization (if necessary, also correlates with a reduction in the rate of re-hospitalization, which combined with close follow-up diabetes can result in a reduction of chronic complications.
Full Text Available Information Technology has responded to the crisis by change and innovation. Competitive organizations are permanently prepared to identify the cutting-edge technologies which will change the future in business by using the concept of Business Intelligence. Information Technology is developing rapidly and providing decision makers with large amounts of information that require processing and analysis. Business Intelligence are critical decisions support applications, their role being to provide to management, based on information from the company, a landscape of its situation at some time, but also predictions on the medium and long term. This paper describes the architecture of the Business Intelligence Platform and highlights the benefits of using decision support systems for business applications. Nowadays, company executives require relevant and accurate business information in real-time to take strategic decisions. It is also essential to have freedom to access this information anywhere and anytime. There is a real need to extend this functionality beyond the office and on the fingertips of the decision makers. After a presentation of the concept of Data mining with examples from a case study, the paper focuses on the potential of the IT&C decisional sector, which embeds simulation and assistance tools for managerial decisions. Developing new methods for predictive modelling and application of existing techniques in many areas will be a permanent concern for both researchers and companies that are interested to gain competitive advantages.
Zuo, Lin; Benson, Sally
for storage security. Falta et al.  show that if carbonated brine migrates upwards and exsolution occurs, brine migration would be greatly reduced and limited by the presence of exsolved CO2 and the consequent low relatively permeability to brine. Similarly, if an exsolved CO2 phase were to evolve in seals, for example, after CO2 injection stops, the effect would be to reduce the permeability to brine and the CO2 would have very low mobility. This flow blocking effect is also studied with water/oil/CO2 [Zuo et al., 2013]. Experiments show that exsolved CO2 performs as a secondary residual phase in porous media that effectively blocks established water flow paths and deviates water to residual oil zones, thereby increasing recovery. Overall, our studies suggest that CO2 exsolution provides an opportunity for mobility control in subsurface processes. However, the lack of simulation capability that accounts for differences between gas injection and gas exsolution creates challenges for modeling and hence, designing studies to exploit the mobility reduction capabilities of CO2 exsolution. Using traditional drainage multiphase flow parameterization in simulations involving exsolution will lead to large errors in transport rates. Development of process dependent parameterizations of multiphase flow properties will be a key next step and will help to unlock the benefits from gas exsolution. ACKNOWLEDGEMENT This work is funded by the Global Climate and Energy Project (GCEP) at Stanford University. This work was also supported by U.S. EPA, Science To Achieve Results (STAR) Program, Grant #: 834383, 2010-2012. REFERENCES Falta, R., L. Zuo and S.M. Benson (2013). Migration of exsolved CO2 following depressurization of saturated brines. Journal of Greenhouse Gas Science and Technology, 3(6), 503-515. Zuo, L., S.C.M. Krevor, R.W. Falta, and S.M. Benson (2012). An experimental study of CO2 exsolution and relative permeability measurements during CO2 saturated water
Conn, Kelly M; Fisher, Susan G; Rhee, Hyekyun
Little is known about the emotional intelligence (EI) of parents and their children with asthma. Objectives of this study were to assess: 1) parent's and children's report of emotions in response to an asthma vignette (proxy for EI) and 2) the relationship between emotions, self-management behaviors, and symptoms. We conducted a descriptive, mixed methods study of children 7-12 years old with asthma. Parent-Child dyads (n=104) responded to an asthma vignette to gain insight into emotions, symptoms, and self-management behaviors. Additional questions assessed confidence and worry using a 5-point Likert scale. Thematic analyses and descriptive statistics were used to assess qualitative and quantitative outcomes. Children were predominantly male (58%), 7-9 (58%), and White (46%). The most common negative emotions reported by children were scared and sad. Children who sought help from an adult were less likely to report using medications compared to children who did not seek help (39.5% vs. 62.3%, p=.029). Children with low worry and high confidence had fewer symptoms compared to children reporting high worry and low confidence (symptoms: days 3.24 vs. 6.77, p=.012, nights 2.71 vs. 5.36, p=.004). Children provided appropriate emotional responses to the asthma vignette; emotions were related to self-management behaviors and symptoms. More studies are needed to specifically assess EI in this population. Parents and children with greater EI may be better able to understand their needs, engage in self-management behaviors, and communicate with their nurses, to improve their support network and ability to access services. Copyright © 2016 Elsevier Inc. All rights reserved.
Elliott, Jennifer Padden; Marcotullio, Nicole; Skoner, David P; Lunney, Phil; Gentile, Deborah A
To evaluate the effectiveness of asthma education delivered by student pharmacists and to assess the impact of child and caregiver baseline asthma knowledge on asthma control in children. Student pharmacists developed and implemented asthma self-management education interventions for children and their caregivers and performed asthma screenings for children at a series of asthma camps. Eighty-seven children, ages 5-17 years, and their caregivers were enrolled in this study. A previously validated asthma questionnaire was modified to assess asthma knowledge among children and adults. Asthma knowledge increased significantly in children following participation in the education intervention (pasthma. A significant association was observed between caregiver baseline asthma knowledge and better asthma control in their children (p=0.019). The results of this study demonstrate that student pharmacist-delivered asthma education can positively impact asthma knowledge in children, and that caregivers' knowledge of asthma is strongly correlated with better asthma control in their children.
Full Text Available The paper examines tourism sector development in the Republic of Bulgaria in the context of the country’s strategic priorities till 2020 of knowledge-based economy, sustainable growth and smart specialization, the opportunities for its integration with agri-food sector and potential contribution to balanced rural development. The principles and roles of destination management and marketing organizations are discussed and the opportunities for their application in the national conditions are explored. A framework for of establishment, management and functioning of such organizations is proposed based on integrated and participatory approaches, planning, coordination and communication activities, permanent monitoring and controlling.
Lau, Annie Y S; Arguel, Amaël; Dennis, Sarah; Liaw, Siaw-Teng; Coiera, Enrico
Personally controlled health management systems (PCHMS), which may include a personal health record (PHR), health management tools, and information resources, have been advocated as a next-generation technology to improve health behaviors and outcomes. There have been successful trials of PCHMS in various health settings. However, there is mixed evidence for whether consumers will use these systems over the long term and whether they ultimately lead to improved health outcomes and behaviors. The aim was to test whether use of a PCHMS by consumers can increase the uptake or updating of a written asthma action plan (AAP) among adults with asthma. A 12-month parallel 2-group randomized controlled trial was conducted. Participants living with asthma were recruited nationally in Australia between April and August 2013, and randomized 1:1 to either the PCHMS group or control group (online static educational content). The primary outcome measure was possession of an up-to-date written AAP poststudy. Secondary measures included (1) utilizing the AAP; (2) planned or unplanned visits to a health care professional for asthma-related concerns; (3) severe asthma exacerbation, inadequately controlled asthma, or worsening of asthma that required a change in treatment; and (4) number of days lost from work or study due to asthma. Ancillary analyses examined reasons for adoption or nonadoption of the intervention. Outcome measures were collected by online questionnaire prestudy, monthly, and poststudy. A total of 330 eligible participants were randomized into 1 of 2 arms (intervention: n=154; control: n=176). Access to the PCHMS was not associated with a significant difference in any of the primary or secondary outcomes. Most participants (80.5%, 124/154) did not access the intervention or accessed it only once. Despite the intervention being effective in other preventive care settings, system use was negligible and outcome changes were not seen as a result. Consumers must perceive
Kouba, Joanne; Velsor-Friedrich, Barbarba; Militello, Lisa; Harrison, Patrick R.; Becklenberg, Amy; White, Barb; Surya, Shruti; Ahmed, Avais
Asthma is the most prevalent chronic illness in childhood affecting 7 million youth. Many youth with asthma face another risk factor in obesity. Obesity, in turn, increases disorders such as asthma. Studies have recommended that asthma programs also address weight management in youth. Taking this into consideration, the I Can Control Asthma and…
Full Text Available Abstract Background This study examined the attitudes and actions of 3415 physician-recruited adults aged ≥ 16 years with asthma in eleven countries who were prescribed regular maintenance therapy with inhaled corticosteroids or inhaled corticosteroids plus long-acting β2-agonists. Methods Structured interviews were conducted to assess medication use, asthma control, and patients' ability to recognise and self-manage worsening asthma. Results Despite being prescribed regular maintenance therapy, 74% of patients used short-acting β2-agonists daily and 51% were classified by the Asthma Control Questionnaire as having uncontrolled asthma. Even patients with well-controlled asthma reported an average of 6 worsenings/year. The mean period from the onset to the peak symptoms of a worsening was 5.1 days. Although most patients recognised the early signs of worsenings, the most common response was to increase short-acting β2-agonist use; inhaled corticosteroids were increased to a lesser extent at the peak of a worsening. Conclusion Previous studies of this nature have also reported considerable patient morbidity, but in those studies approximately three-quarters of patients were not receiving regular maintenance therapy and not all had a physician-confirmed diagnosis of asthma. This study shows that patients with asthma receiving regular maintenance therapy still have high levels of inadequately controlled asthma. The study also shows that patients recognise deteriorating asthma control and adjust their medication during episodes of worsening. However, they often adjust treatment in an inappropriate manner, which represents a window of missed opportunity.
Tacila Pires Mega
Full Text Available Asthma is a chronic inflammatory disease of the airways that may lead to limitations in regular activities, to hospitalizations and a decrease in quality of life. Adherence to drug treatment is crucial for control of the disease. The use of medicinal herbs can reduce adherence to prescriptions, as the medication may be replaced by infusions or herbal products. The objective of this study was to evaluate the frequency of use of traditional herbal medicine among severe asthmatics in Salvador. Information on use of homemade remedies was obtained through application of a questionnaire during patient visits to a referral center. We also collected data on economic and social aspects as well as disease control. One hundred and forty-four (91,1% out of one hundred and fifty-eight patients evaluated used herbal medicines, but only 26.5% attributed improvement of asthma symptoms to this alternative treatment and only 8 had substituted a prescribed medication by herbal medicines. There was a trend towards lower adherence to prescription drug treatment in this group of patients. Despite the high frequency of use of medicinal herbs in our sample, there was no improvement in the asthma treatment in this population compared to non-users. Adherence to conventional drug treatment was satisfactory and there was neither reduction in asthma control nor increase in hospitalizations among the users of medicinal plants.A asma é uma enfermidade inflamatória crônica das vias aéreas que pode resultar em limitações nas atividades diárias, internações e prejuízo da qualidade de vida. A adesão ao tratamento medicamentoso é fundamental para o controle da doença. O uso de plantas medicinais pode reduzir a adesão ao tratamento prescrito, à medida que os medicamentos são substituídos por chás ou ervas. O objetivo deste estudo foi avaliar a frequência de uso de plantas medicinais entre asmáticos graves em Salvador. As informações sobre uso de rem
Veenith Tonny V
Full Text Available Abstract Introduction Lactic acidosis often occurs in severely unwell patients presenting to Accident and Emergency. It is commonly associated with either hypoxia or decreased tissue perfusion secondary due to cardiovascular collapse or sepsis. Case presentation We present a case of severe lactic acidosis in the presence of normal tissue perfusion and oxygenation in a 31-year-old patient with poorly-controlled asthma. Acidosis promptly reversed on discontinuation of inhaled beta-agonists. Conclusion Lactic acidosis secondary to inhaled beta-agonist administration may be a common scenario which can be misinterpreted very easily and can confuse the clinical picture. Further studies will be needed to establish the exact aetiology of this lactic acid production.
O. K. Коloskova
Full Text Available Content of peculiarities of basic anti-inflammatory therapy and its efficacy in children with available or absent deletion polymorphism of GSTM1 and GSTT1 genes coding II phase enzymes of GSTM1 and GSTT1 xenobiotic detoxication considering their acetylation status. It is established that in patients of a school age suffering from bronchial asthma with available deletion polymorphism of GSTT1 and GSTМ1 genes associated with slow acetylation phenotype anti-inflammatory therapy should be intensified emphasizing on much higher “step” or by means of addition of other anti-inflammatory drugs. In patients without deletion polymorphism of the examined genes in terms of quick acetylation phenotype average daily doses of iGCS have a tendency to prevailing over the similar ones in patients from the groups of comparison, and their triple administration is reliably higher
Yin, Hsiang Shonna; Gupta, Ruchi S; Mendelsohn, Alan L; Dreyer, Benard; van Schaick, Linda; Brown, Christina R; Encalada, Karen; Sanchez, Dayana C; Warren, Christopher M; Tomopoulos, Suzy
The objective of the study was to determine whether parents who use a low-literacy, pictogram- and photograph-based written asthma action plan (WAAP) have a better understanding of child asthma management compared to parents using a standard plan. A randomized controlled study was carried out in 2 urban pediatric outpatient clinics. Inclusion criteria were English- and Spanish-speaking parents of 2- to 12-year-old asthmatic children. Parents were randomized to receive a low-literacy or standard asthma action plan (American Academy of Allergy, Asthma and Immunology) for a hypothetical patient on controller and rescue medications. A structured questionnaire was used to assess whether there was an error in knowledge of (1) medications to give everyday and when sick, (2) need for spacer use, and (3) appropriate emergency response to give albuterol and seek medical help. Multiple logistic regression analyses were performed, adjusting for parent age, health literacy (Newest Vital Sign); child asthma severity, medications; and site. 217 parents were randomized (109 intervention and 108 control). Parents who received the low-literacy plan were (1) less likely to make an error in knowledge of medications to take everyday and when sick compared to parents who received the standard plan (63.0 vs. 77.3%, p = 0.03; adjusted odds ratio [AOR] = 0.5[95% confidence interval: 0.2-0.9]) and (2) less likely to make an error regarding spacer use (14.0 vs. 51.1%, p plan improves child asthma outcomes.
Porsbjerg, Celeste; Menzies-Gow, Andrew
Patients with severe asthma represent a minority of the total asthma population, but carry a majority of the morbidity and healthcare costs. Achieving better asthma control in this group of patients is therefore of key importance. Systematic assessment of patients with possible severe asthma...... to identify treatment barriers and triggers of asthma symptoms, including co-morbidities, improves asthma control and reduces healthcare costs and is recommended by international guidelines on management of severe asthma. This review provides the clinician with an overview of the prevalence and clinical...... impact of the most common co-morbidities in severe asthma, including chronic rhinosinusitis, nasal polyposis, allergic rhinitis, dysfunctional breathing, vocal cord dysfunction, anxiety and depression, obesity, obstructive sleep apnoea syndrome (OSAS), gastroesophageal reflux disease (GERD...
von Bülow, Anna; Kriegbaum, Margit; Backer, Vibeke
asthma, the extent of asthma control, and contact with specialist care. METHODS: A descriptive cross-sectional register study was performed. By using a nationwide prescription database, we identified current patients with asthma (age, 18-44 years) in 2010. Severity was classified as severe versus mild......-moderate asthma according to the level of antiasthma treatment. We investigated prescription drug use, hospitalizations, emergency department visits, and outpatient clinic visits according to severity. RESULTS: Among a nationwide population, we identified 61,583 current patients with asthma. Based on the level...... asthma and low asthma control were not managed by specialist care. Patients with severe asthma with specialist contact more frequently had impaired asthma control compared with subjects not treated by a specialist (44.4% vs 33.1%, P
Full Text Available The Saudi Initiative for Asthma (SINA provides up-to-date guidelines for healthcare workers managing patients with asthma. SINA was developed by a panel of Saudi experts with respectable academic backgrounds and long-standing experience in the field. SINA is founded on the latest available evidence, local literature, and knowledge of the current setting in Saudi Arabia. Emphasis is placed on understanding the epidemiology, pathophysiology, medications, and clinical presentation. SINA elaborates on the development of patient-doctor partnership, self-management, and control of precipitating factors. Approaches to asthma treatment in SINA are based on disease control by the utilization of Asthma Control Test for the initiation and adjustment of asthma treatment. This guideline is established for the treatment of asthma in both children and adults, with special attention to children 5 years and younger. It is expected that the implementation of these guidelines for treating asthma will lead to better asthma control and decrease patient utilization of the health care system.
Park, Young Ki
This study explains the role of information technologies in enabling organizations to successfully sense and manage opportunities and threats and achieve competitive advantage in turbulent environments. I use two approaches, a set-theoretic configurational theory approach and a variance theory approach, which are theoretically and methodologically…
Full Text Available ... for Control Triggers Indoors In the Workplace Outdoors Management Asthma Action ... – Hospital Emergency Departments Adults – Hospital Inpatients Adults – Medical clinics/ ...
Full Text Available ... on Spirometry Parents Preventing and Controlling Tools for Control Triggers Indoors In the Workplace Outdoors Management Asthma Action Plan Flu Shots Inhalers Data, Statistics, ...
... Accessed February 28, 2018. Durrani SR, Busse WW. Management of asthma in adolescents and adults. In: Adkinson NF Jr, Bochner BS, Burks AW, et al, eds. Middleton's Allergy: Principles and Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap ...
Guillermo A. Raimondi
con las pautas de calidad aceptadas o con los guías de manejo de la enfermedad.A total of 518 chest physicians selected at random from a national list participated in a survey on asthma management. This paper dealt with queries about diagnostic procedures, methods for recognizing life-threatening asthma attacks, patient education and treatment for acute asthma in adults and in children older than 6 years. A total of 198 replies were received (38.2% of questionnaires mailed. A mean score of frequency of use (from 0 = never to 3 = always was used for assessing the responses. Results were compared with a similar survey performed in 1994, disclosing a satisfactory trend in diagnostic tests with the bronchodilator test and in oral steroid courses (2.74 ±2.3 vs 2.30±1.05 and 1.26±0.96 vs 0.98+±0.84, respectively. Skin tests were less used (0.50±0.83 vs 0.88±1.08. Results reporting how to assess the severity of asthma attacks, such as taking into account symptoms or drop in PEFR, were more frequent in the present study (2.65±0.66 vs 2.29±0.90 and 1.93±1.05 vs 1.51±1.20, respectively. PEFR or spirometry used by the physician for assessing severity of asthma attacks was not always performed and its comparison was no better than in 1994 (2.14±1.04 vs 2.13±0.70. Data regarding patient information and education ranked equal or better than in the 1994 survey. For the treatment of acute severe episodes, almost all responders in the present study chose inhaled b2 agonists (IBA for adults and children, thus improving with respect to the previous study (first option 85.3 vs 57.5% and 81.0 vs 63.4%, respectively. For maintenance therapy, a good trend was also observed with more responders who now chose inhaled steroid (IS as a first choice formulation, specially in children (2.09±1.01 vs 1.61±1.00. The average normal and maximal daily doses of IS for adults and children were higher than in 1994 and were now in agreement with recommended doses. The recommendation of short
... harm people too. Try to use pest management methods that pose less of a risk. Keep counters, sinks, tables and floors clean and ... with pest challenges in your home and other environments. [EPA ... pests while reducing pesticide risks; roaches are often asthma triggers and shouldn’t ...
Backer, Vibeke; Lykkegaard, Jesper; Bodtger, Uffe
AIM OF THE DATABASE: Asthma is the most prevalent chronic disease in children, adolescents, and young adults. In Denmark (with a population of 5.6 million citizens), >400,000 persons are prescribed antiasthmatic medication annually. However, undiagnosed cases, dubious diagnoses, and poor asthma...... management are probably common. The Danish National Database for Asthma (DNDA) was established in 2015. The aim of the DNDA was to collect the data on all patients treated for asthma in Denmark and to monitor asthma occurrence, the quality of diagnosis, and management. STUDY POPULATION: Persons above the age...... year, the inclusion criteria are a second purchase of asthma prescription medicine within a 2-year period (National Prescription Registry) or a diagnosis of asthma (National Patient Register). Patients with chronic obstructive pulmonary disease are excluded, but smokers are not excluded. DESCRIPTIVE...
Delafosse-Le Ber, H.; Deysson, St.; Briault, S.
The interest of these six years spent to build the management through the Risks and the Opportunities (R and O) approach on the project Megajoule Laser as well did not hold with the practical application of a method as to the installation of a formal culture and to its evolution in time. This culture, it had to be progressively founded within a mainly technical project team. More qualitative with most quantitative aspects, the putting into practice of the R and O approach on project LMJ knew all the degrees of evolution and precision. The starting of the project saw being born the first analysis of its 'Project Risk' with a series of interviews, carried out by the Quality Manager at the time. This analysis took the shape of a technical item lists, which are identified in an empirical way. Then, some brainstorming meeting were led under the responsibility of the Technical Coordinator (which is the Project Manager assistant) in order to identify and to evaluate the 'Project Risk' on a qualitative way, but always keeping a strong technical connotation. The methodological reference of the 'Project Risk' was outlined taking into account the DGA AQ 923 without directly interaction with the other project processes (for example, the cost, the deadlines and the performance management). Initially, the project developed an Access database, which allows the storing of the risk files. Unfortunately, this database is isolated from the other project management data processing tools. In the second time, the project decided to obtain a dedicated organisation, hierarchically independent from the technical managers but however integrated into the project and attached to the assistant of the Control Project Manager. This organisation being called 'Risks and Opportunities Team', when the management of the opportunities supplemented the R and O approach. This team combines today the individual interviews and the Working Groups in order to identify and to evaluate the effects of the R
Reid, D; Abramson, M; Raven, J; Walters, H E
As part of the European Community Respiratory Health Survey (ECRHS) in 1992-1993 we assessed management practices and treatment perceptions among young asthmatic adults in Melbourne, Australia. We conducted a postal questionnaire survey of 4500 randomly selected adults (aged 20-44 years), drawn from three electoral districts, of whom 3200 (71%) subjects responded. A randomly selected sample of 1642 respondents, 'enriched' by a further 433 symptomatic subjects, was invited to complete a second phase respiratory questionnaire. The questionnaire was completed by 757 subjects who underwent laboratory testing. A further 119 subjects who were unable to attend the laboratory completed an identical questionnaire by telephone interview (42% response rate). In the second phase, 16% of subjects reported 'current asthma' (group I) as defined by physician confirmation and a recent attack (within 1 year), 10% had confirmed asthma but reported no recent attack (group II) and 74% did not have asthma (group III). Inhaled corticosteroid use was significantly higher in group I than in group II subjects (45% vs 24%, Ptime. Despite national education campaigns, the majority of young asthmatic adults in Melbourne did not adhere to prescribed treatment, but continued to rely upon beta2-agonists alone with neglect of regular inhaled corticosteroid which has probably contributed to Australia's continued high asthma morbidity and mortality rates.
Kligler, Benjamin; Homel, Peter; Blank, Arthur E; Kenney, Jeanne; Levenson, Hanniel; Merrell, Woodson
The purpose of this study was to test the effectiveness of an integrative medicine approach to the management of asthma compared to standard clinical care on quality of life (QOL) and clinical outcomes. This was a prospective parallel group repeated measurement randomized design. Participants were adults aged 18 to 80 years with asthma. The intervention consisted of six group sessions on the use of nutritional manipulation, yoga techniques, and journaling. Participants also received nutritional supplements: fish oil, vitamin C, and a standardized hops extract. The control group received usual care. Primary outcome measures were the Asthma Quality of Life Questionnaire (AQLQ), The Medical Outcomes Study Short Form-12 (SF-12), and standard pulmonary function tests (PFTs). In total, 154 patients were randomized and included in the intention-to-treat analysis (77 control, 77 treatment). Treatment participants showed greater improvement than controls at 6 months for the AQLQ total score (PMental health (P= .003 and .02, respectively). There was no change in PFTs in either group. A low-cost group-oriented integrative medicine intervention can lead to significant improvement in QOL in adults with asthma.
The Department of Energy's Low-Level Waste Management Program (DOE LLWMP) perspective in regard to transfer of LLWMP technology to current and potential users in both the commercial and defense sectors is discussed. Past, present, and future opportunities and challenges for the whole nuclear waste management are indicated. Elements considered include: historical and evolutionary events and activities; the purpose of the Program and its inherent opportunities and challenges; achievements and expected accomplishments; supporters and interactors; packaging and delivering technology; implementing and serving potential users; determining and meeting users' needs; and identifying and responding to opportunities and challenges. The low-level waste management effort to improve shallow land burial technology began in FY 1977 and has expanded to include waste treatment and alternative disposal methods. Milestones have been established and are used as principal management control items. This technology, the Program Product, is described and is made available. This year, the Program has drafted criteria for inclusion in a DOE order for radioactive waste management operations at DOE sites
Expansion of both water and wastewater treatment plants increases the quantity of resulting sludge that must be processed. This report focuses on alternative sludge processing technologies, which may pre sent opportunities for managing the amount of electricity required to power processing equipment. Overall, the report provides information on the electrotechnologies used in sludge management systems, defines opportunities in the design and operation of water and wastewater sludge management systems for more efficient use of electric power, and identifies possible areas for research and development that would enhance the design of energy-efficient systems. The sludge operations and processes covered in this report include pumping, thickening, stabilization, conditioning and dewatering, heat drying, and thermal reduction
... Development Infections Diseases & Conditions Pregnancy & Baby Nutrition & Fitness Emotions & Behavior School & Family Life First Aid & Safety Doctors & ... Can I Deal With My Asthma? Allergy Testing Definition: Allergy-Triggered Asthma Asthma Center Asthma View more ...
... for Educators Search English Español Do Allergies Cause Asthma? KidsHealth / For Parents / Do Allergies Cause Asthma? Print ... son la causa del asma? Do Allergies Cause Asthma? Allergies don't cause asthma. But kids who ...
... Videos for Educators Search English Español School and Asthma KidsHealth / For Kids / School and Asthma Print en ... Let's find out. Why Do I Need an Asthma Action Plan? When you're dealing with asthma, ...
... Español Text Size Email Print Share Exercise and Asthma Page Content Article Body Almost every child (and ... of Pediatrics about asthma and exercise. What is asthma Asthma is the most common chronic medical problem ...
... and Data > Minority Population Profiles > Hispanic/Latino > Asthma Asthma and Hispanic Americans In 2015, 2.2 million Hispanics reported that they currently have asthma. Puerto Rican Americans have almost twice the asthma ...
Stritch, Justin Michael; Pedersen, Mogens Jin; Taggert, Gabel
Other social science fields are increasingly conducting research using Amazon’s Mechanical Turk (MTurk)—an online crowdsourcing platform—but how might MTurk be useful to public administration and management research? This article provides an introduction of the platform and considers both...... the opportunities and limitations for using MTurk in public administration and management scholarship. We find that MTurk might be relevant for examining particular types of research questions. We identify five areas where MTurk data may complement and enhance public administration and management research: (1...
Liu, Andrew H; Anderson, William C; Dutmer, Cullen M; Searing, Daniel A; Szefler, Stanley J
In 2015, progress in understanding asthma ranged from insights to asthma inception, exacerbations, and severity to advancements that will improve disease management throughout the lifespan. 2015's insights to asthma inception included how the intestinal microbiome affects asthma expression with the identification of specific gastrointestinal bacterial taxa in early infancy associated with less asthma risk, possibly by promoting regulatory immune development at a critical early age. The relevance of epigenetic mechanisms in regulating asthma-related gene expression was strengthened. Predicting and preventing exacerbations throughout life might help to reduce progressive lung function decrease and disease severity in adulthood. Although allergy has long been linked to asthma exacerbations, a mechanism through which IgE impairs rhinovirus immunity and underlies asthma exacerbations was demonstrated and improved by anti-IgE therapy (omalizumab). Other key molecular pathways underlying asthma exacerbations, such as cadherin-related family member 3 (CDHR3) and orosomucoid like 3 (ORMDL3), were elucidated. New anti-IL-5 therapeutics, mepolizumab and reslizumab, were US Food and Drug Administration approved for the treatment of patients with severe eosinophilic asthma. In a clinical trial the novel therapeutic inhaled GATA3 mRNA-specific DNAzyme attenuated early- and late-phase allergic responses to inhaled allergen. These current findings are significant steps toward addressing unmet needs in asthma prevention, severity modification, disparities, and lifespan outcomes. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Jørgensen, Inger Merete; Jensen, V B; Bülow, S
Child death due to asthma is a rare and potentially preventable event. We investigated possible risk factors for death due to asthma in children and adolescents, as a step towards preventing or minimizing asthma death in this age group, and improving asthma management and care. We reviewed all 108...... children and young adults should regularly receive medical care and assessment, even if they suffer only a few symptoms. This study underlines the need for ongoing education of the patient's family, the patient, and doctors on long-term management and management of acute attacks. Copies of clearly written...
Kong, Ming Ley; Armour, Carol; LeMay, Kate; Smith, Lorraine
To describe the information needs of a group of Australians with asthma and the extent to which their needs had been met. A self-administered survey was completed by people with asthma either presenting at community pharmacies or registered with a medical research institute database. The survey questions were developed based on a review of the literature, and included questions regarding participants' information needs about their asthma, their sources of asthma information and the extent to which these information needs had been met. The responses concerning information needs were analysed thematically. Responses concerning sources of asthma information and the extent to which needs were met were analysed using descriptive and correlational statistics. Seventy-one people completed the survey. Key information needs that were identified included medications, management of asthma, asthma triggers, cure, aetiology of asthma and latest research. A third of participants reported having only 'very little', 'a little' or 'some' of their information needs met. The most common source of information was from a doctor (94% respondents), followed by a pharmacist or pharmacy assistant (56%). Insights into the information needs of people with asthma have been provided. In light of the level of unmet information needs of people with asthma, and the types of information sought, pharmacists are in an ideal position to close the information gap and promote optimal asthma self-management practices. © 2013 Royal Pharmaceutical Society.
van Gaalen, Johanna L; Bakker, Moira J; van Bodegom-Vos, Leti; Snoeck-Stroband, Jiska B; Assendelft, Willem J J; Kaptein, Ad A; van der Meer, Victor; Taube, Christian; Thoonen, Bart P; Sont, Jacob K
Internet-based self-management (IBSM) support cost-effectively improves asthma control, asthma related quality of life, number of symptom-free days, and lung function in patients with mild to moderate persistent asthma. The current challenge is to implement IBSM in clinical practice. This study is a three-arm cluster randomized trial with a cluster pre-randomisation design and 12 months follow-up per practice comparing the following three IBSM implementation strategies: minimum strategy (MS): dissemination of the IBSM program; intermediate strategy (IS): MS + start-up support for professionals (i.e., support in selection of the appropriate population and training of professionals); and extended strategy (ES): IS + additional training and ongoing support for professionals. Because the implementation strategies (interventions) are primarily targeted at general practices, randomisation will occur at practice level.In this study, we aim to evaluate 14 primary care practices per strategy in the Leiden-The Hague region, involving 140 patients per arm. Patients aged 18 to 50 years, with a physician diagnosis of asthma, prescription of inhaled corticosteroids, and/or montelukast for ≥3 months in the previous year are eligible to participate. Primary outcome measures are the proportion of referred patients that participate in IBSM, and the proportion of patients that have clinically relevant improvement in the asthma-related quality of life. The secondary effect measures are clinical outcomes (asthma control, lung function, usage of airway treatment, and presence of exacerbations); self-management related outcomes (health education impact, medication adherence, and illness perceptions); and patient utilities. Process measures are the proportion of practices that participate in IBSM and adherence of professionals to implementation strategies. Cost-effective measurements are medical costs and healthcare consumption. Follow-up is six months per patient. This study
van Gaalen Johanna L
Full Text Available Abstract Background Internet-based self-management (IBSM support cost-effectively improves asthma control, asthma related quality of life, number of symptom-free days, and lung function in patients with mild to moderate persistent asthma. The current challenge is to implement IBSM in clinical practice. Methods/design This study is a three-arm cluster randomized trial with a cluster pre-randomisation design and 12 months follow-up per practice comparing the following three IBSM implementation strategies: minimum strategy (MS: dissemination of the IBSM program; intermediate strategy (IS: MS + start-up support for professionals (i.e., support in selection of the appropriate population and training of professionals; and extended strategy (ES: IS + additional training and ongoing support for professionals. Because the implementation strategies (interventions are primarily targeted at general practices, randomisation will occur at practice level. In this study, we aim to evaluate 14 primary care practices per strategy in the Leiden-The Hague region, involving 140 patients per arm. Patients aged 18 to 50 years, with a physician diagnosis of asthma, prescription of inhaled corticosteroids, and/or montelukast for ≥3 months in the previous year are eligible to participate. Primary outcome measures are the proportion of referred patients that participate in IBSM, and the proportion of patients that have clinically relevant improvement in the asthma-related quality of life. The secondary effect measures are clinical outcomes (asthma control, lung function, usage of airway treatment, and presence of exacerbations; self-management related outcomes (health education impact, medication adherence, and illness perceptions; and patient utilities. Process measures are the proportion of practices that participate in IBSM and adherence of professionals to implementation strategies. Cost-effective measurements are medical costs and healthcare consumption
Latycheva, O; Chera, R; Hampson, C; Masuda, J R; Stewart, M; Elliott, S J; Fenton, N E
Asthma is a growing concern in First Nations and Inuit communities. As with many health indicators and outcomes, Aboriginal peoples living in remote areas experience greater disparities in respiratory health compared with non-Aboriginal Canadians. Therefore, it is critically important to take into account their unique needs when developing asthma educational materials and resources. The purpose of this study is to assess the cultural relevance of existing asthma education materials for First Nations and Inuit peoples. Five First Nations and Inuit communities from across Canada participated in the project. A combination of quantitative evaluations (eg surveys) and qualitative approaches (eg open discussion, live chats) were used to assess printed and web-based asthma education materials. Participants represented First Nations and Inuit communities from across Canada and were selected on the basis of age and role: 6 to 12 years old (children), 12 and over (youth), parents and grandparents, community leaders and teachers, and community advisory group members. In general, the results showed that although participants of all age categories liked the selection of asthma educational materials and resources, they identified pictures and images related to First Nations and Inuit people living and coping with asthma as ways of improving cultural relevance. This reinforces findings that tailoring materials to include Aboriginal languages, ceremonies and traditions would enhance their uptake. Our findings also demonstrate that visually based content in both printed and virtual form were the preferred style of learning of all participants, except young children who preferred to learn through play and interactive activities. Asthma is a growing concern in First Nations and Inuit communities. Given this concern, it is essential to understand cultural needs and preferences when developing asthma education materials and resources. The findings from this research emphasize the need
Despite the large number of women in the healthcare field, healthcare management resembles other industries in its severe lack of women in upper-management positions and in the "glass ceiling" that contributes to this dearth. Although not enough has been specifically written on women healthcare managers, the author reviews what is available, along with some of the general management literature.
Dürr, Selina; Hersberger, Kurt E; Zeller, Andreas; Scheuzger, Jonas; Miedinger, David; Gregoriano, Claudia; Joos Zellweger, Ladina; Steurer-Stey, Claudia; Leuppi, Jörg Daniel
Despite great efforts in establishing optimal asthma management, asthma may remain uncontrolled. To effectively manage chronic diseases, such as asthma, it is important to train patients in self-management skills. The aim of this study was to assess the potential benefit of standardised asthma education in Switzerland for asthma control and patients' perception of received asthma care and of self-management support. For this multicentre longitudinal controlled study, asthma patients were recruited in Switzerland. The Asthma Control Test (ACT) was used to assess asthma control. The Patient Assessment of Chronic Illness Care questionnaire (PACIC 5A) was applied to evaluate received health-care services and self-management support. Patients were offered the possibility to attend asthma education sessions conducted by the Swiss Lung League and Swiss Allergy Centre. After 1 year, attenders and non-attenders completed the questionnaires again. Changes in ACT and PACIC 5A scores were analysed using dependent t tests. Overall, 223 patients with asthma were investigated (mean age 43 ± 12 years, 38% male, 13% current smokers, 29% ex-smokers). Sixty-one (27%) patients attended education sessions. Both groups had improved asthma control at follow-up (attenders: t(56) = -3.2, r = 0.4 [medium effect size], p = 0.002; non-attenders: t(141) = -2.6, r = 0.2 [small effect size], p = 0.010). Attenders improved in PACIC and 5A sum scores (t(50) = -3.6, r = 0.5 [medium effect size], p = 0.001). A comprehensive self-management asthma education programme in Switzerland improved asthma control and patients' perception of received asthma care and of self-management support. Professionals should motivate patients to attend asthma education in order to become active partners in managing their disease. © 2017 S. Karger AG, Basel.
Mi Sun Park
Full Text Available Participation by multiple actors has been emphasized in managing state forests to meet various demands on forests within a global society. Public participation was also suggested as an approach to sustainable forest management. This paper aims to investigate the legal opportunities of public participation in managing state forests in the case of the Republic of Korea (ROK. Relevant legal and policy documents were selected for content analysis and were analyzed with the levels of participation. Litigation regarding state forest conflicts was analyzed. The ROK legal system includes multiple levels of participation in managing state forests: information sharing, consultation, collaborative decision-making, and implementation. The research results indicate that various stakeholders need legal opportunities to participate in the formation and implementation of policies for the management of state forests. Regulatory enforcement is required for guaranteeing environmental rights—access to information, participation in decision-making, and standing in court. Based on research results, this paper provides us with legal insights on promoting public participation in managing state forests.
Mazurek, Jacek M; Syamlal, Girija
In 2010, an estimated 8.2% of U.S. adults had current asthma, and among these persons, 49.1% had had an asthma attack during the past year (1). Workplace exposures can cause asthma in a previously healthy worker or can trigger asthma exacerbations in workers with current asthma* (2). To assess the industry- and occupation-specific prevalence of current asthma, asthma attacks, and asthma-related emergency department (ED) visits among working adults, CDC analyzed 2011-2016 National Health Interview Survey (NHIS) data for participants aged ≥18 years who, at the time of the survey, were employed at some time during the 12 months preceding the interview. During 2011-2016, 6.8% of adults (11 million) employed at any time in the past 12 months had current asthma; among those, 44.7% experienced an asthma attack, and 9.9% had an asthma-related ED visit in the previous year. Current asthma prevalence was highest among workers in the health care and social assistance industry (8.8%) and in health care support occupations (8.8%). The increased prevalence of current asthma, asthma attacks, and asthma-related ED visits in certain industries and occupations might indicate increased risks for these health outcomes associated with workplace exposures. These findings might assist health care and public health professionals in identifying workers in industries and occupations with a high prevalence of current asthma, asthma attacks, and asthma-related ED visits who should be evaluated for possible work-related asthma. Guidelines intended to promote effective management of work-related asthma are available (2,3).
McCleary, Nicola; Andrews, Amanda; Morrow, Susan; Wiener-Ogilvie, Sharon; Fletcher, Monica; Steed, Liz; Taylor, Stephanie J C; Pinnock, Hilary
Supported self-management for asthma helps people adjust their treatment in response to symptom changes. This improves day-to-day control and reduces the risk of asthma attacks and the need for emergency healthcare. However, implementation remains poor in routine clinical practice. This systematic review is part of a programme of work developing an intervention to help primary care practice teams embed self-management support into routine asthma care. The aim of the review is to synthesise the evidence regarding the effectiveness of educational interventions for professionals supporting self-management in people with asthma or diabetes (type 1 and type 2). These two conditions have the most robust evidence base for the effectiveness of implementing supported self-management. Electronic searches will be conducted in CENTRAL, MEDLINE, EMBASE, ISI Web of Science, CINAHL, PsycINFO, AMED, Global Health, WHO Global Health Library, ERIC, BNI, RDRB/CME and Google Scholar. Eligible studies are randomised controlled trials or controlled clinical trials published between 1990 and 2016 which evaluated professional education interventions facilitating asthma or diabetes supported self-management. Further relevant work will be identified from trial registries, citation searching and through contact with authors of included studies. This will be supplemented by scoping potentially relevant educational packages described in English language policy literature or health service websites. Screening, data extraction and risk of bias assessment (using the Cochrane Risk of Bias Tool) will be completed by two independent reviewers, with a third reviewer arbitrating where necessary. We plan a theoretically informed narrative synthesis of the aggregated data as heterogeneity is likely to preclude meta-analysis. Ethical approval is not required for this systematic review. The results will be described in a paper submitted for peer-reviewed publication and will inform the development of an
K. Liagkouras; K. Metaxiotis
Customer relationship management (CRM) systems in business are a reality of the contemporary business world for the last decade or so. Still, there are grey areas regarding the successful implementation and operation of CRM systems in business. This paper, through the systematic study of the CRM implementation paradigm, attempts to identify the most important challenges and opportunities that the CRM systems face in a rapidly changing business world.
Paulo de Tarso Roth Dalcin
Full Text Available Asma é uma doença com uma alta prevalência em nosso meio e ao redor do mundo. Embora novas opções terapêuticas tenham sido recentemente desenvolvidas, parece haver um aumento mundial na sua morbidade e mortalidade. Em muitas instituições, as exacerbações asmáticas ainda se constituem em uma emergência médica muito comum. As evidências têm demonstrado que o manejo da asma aguda na sala de emergência concentra decisões cruciais que podem determinar o desfecho desta situação clínica. Nesta revisão, enfocaremos a avaliação e o tratamento do paciente com asma aguda na sala de emergência, descrevendo uma estratégia apropriada para o seu manejo. Serão consideradas as seguintes etapas: diagnóstico, avaliação da gravidade, tratamento, avaliação das complicações, decisão sobre onde se realizará o tratamento adicional e orientações por ocasião da alta da emergência. Espera-se que estas recomendações contribuam para que o médico clínico tome as decisões apropriadas durante o manejo da asma aguda na sala de emergência.Asthma is a disease with high prevalence in our country and worldwide. Although new therapeutic approaches have been developed recently, there seems to be a global increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that management of acute asthma in the emergency room entails crucial decisions that could determine the clinical outcome. In this review, the authors focus on assessment and treatment of patients with acute asthma and outline an appropriate management strategy. Diagnosis, severity assessment, treatment, complications, decision about where additional treatment will take place and orientations on discharge from the emergency will be considered. It is expected that these recommendations will help physicians to make the appropriate decisions about care of acute asthma in the emergency
Munkner, L.; Bundgaard, A.
A group of adult patients with perennial bronchial asthma has been studied as to lung perfusion and alveolar ventilation (81m-Kr) at rest and after provocation of an acute attack. Asthma was provoked by exercise and by histamine inhalation. After provocation the peak expiratory flow values were reduced to less than 80% of the base line values. Perfusion was often deranged. Regional ventilation changed rapidly after provocation and not always in the same fashion after exercise and histamine. During attacks lung volume increased. The expansion decreased (in parallel with increased peak expiratory flow) after inhalator of a #betta#-2 agonist (terbutaline). 81m-Kr offers unique opportunities for studying acute regional changes in alveolar ventilation. (Author)
Zahran, Hatice S; Bailey, Cathy M; Qin, Xiaoting; Johnson, Carol
Uncontrolled asthma decreases quality of life and increases health care use. Most people with asthma need daily use of long-term control (LTC) medications for asthma symptoms and to prevent asthma attacks. Ongoing assessment of a person's level of asthma control and medication use is important in determining the effectiveness of current treatment to decrease the frequency and intensity of symptoms and functional limitations. To assess the use of LTC medication among children and adults with current asthma and identify contributing factors for LTC medication use. We used the 2006-2010 Behavioral Risk Factor Surveillance System (BRFSS) child and adult Asthma Call-back Survey (ACBS) data to assess the level of asthma control and LTC medication use. Asthma control was classified as well controlled and uncontrolled using guideline-based measures. We used multivariable logistic regression models to identify contributing factors for LTC medication use and having uncontrolled asthma. Among persons with current asthma, 46.0% of children and 41.5% of adults were taking LTC medications and 38.4% of children and 50.0% of adults had uncontrolled asthma. Among children who had uncontrolled asthma (38.4%), 24.1% were taking LTC medications and 14.3% were not taking LTC medications. Among adults who had uncontrolled asthma (50.0%), 26.7% were taking LTC medications and 23.3% were not taking LTC medications. Using BRFSS ACBS data to assess the level of asthma control and LTC medication use can identify subpopulations of persons with asthma who receive suboptimal treatment, for which better asthma-related medical treatment and management are needed.
... resources Asthma - children Patient Instructions Asthma and school Asthma - child - discharge Asthma - control drugs Asthma - quick-relief drugs Asthma - what to ask the doctor - adult Asthma - what to ask your doctor - child Exercise-induced asthma Exercising and asthma at school ...
Full Text Available After a brief presentation of the aspects regarding the planning of a customer relationship management (CRM project, we emphasize the factors that assure the success of such an approach. In order to obtain the attended results, an organization needs the best selection of the project manager and the most efficient teamwork, which implies employees from the company’s departments and also IT specialists. In the final part, we made appreciations concerning the efficiency of a CRM project and the opportunities created by its implementation.
When an adequate standard of asthma control is not achieved with maintenance treatment of inhaled corticosteroids, the addition of a long-acting beta(2)-adrenergic receptor agonist (LABA) bronchodilator is recommended. Using a combination product, salmeterol/fluticasone propionate (Seretide or Advair) or budesonide/formoterol (Symbicort) is preferred for convenience and avoids any risk that LABA might be used as monotherapy. As formoterol has a rapid onset of bronchodilator effect, the budesonide/formoterol combination can be used for both the maintenance and reliever components of asthma treatment (Symbicort SMART) and this is endorsed as an effective treatment by the Global Initiative for Asthma. The efficacy of this approach has been evaluated in a series of well conducted, controlled studies. Current control of asthma symptoms is improved or achieved with reduced total dose administration with Symbicort SMART compared with any reasonable alternate option. In every study, the risk of severe exacerbations was lower with Symbicort SMART than comparator treatment. Patients who benefit to the greatest extent are those with evidence of more severe asthma and greater exacerbation risk. When initiated in suitable patients in conjunction with appropriate education, Symbicort SMART is dominant in pharmacoeconomic terms. Symbicort SMART delivers improved asthma outcomes with lower treatment and social costs than any alternative.
Malveaux, F J; Fletcher-Vincent, S A
Asthma morbidity and mortality are disproportionately high in urban centers, and minority children are especially vulnerable. Factors that contribute to this dilemma include inadequate preventive medical care for asthma management, inadequate asthma knowledge and management skills among children and their families, psychosocial factors, and environmental exposure to allergens or irritants. Living in substandard housing often constitutes excess exposure to indoor allergens and pollutants. Alle...
Villaire, Michael; Gonzalez, Diana Peña; Johnson, Kirby L
This chapter discusses the need for innovative health literacy solutions to combat extensive chronic disease prevalence and costs. The authors explore the intersection of chronic disease management and health literacy. They provide specific examples of successful health literacy interventions for managing several highly prevalent chronic diseases. This is followed by suggestions on pairing research and practice to support effective disease management programs. In addition, the authors discuss strategies for collection and dissemination of knowledge gained from collaborations between researchers and practitioners. They identify current challenges specific to disseminating information from the health literacy field and offer potential solutions. The chapter concludes with a brief look at future directions and organizational opportunities to integrate health literacy practices to address the need for effective chronic disease management.
Occupational lung diseases such as asthma, COPD and pneumoconioses caused by exposure to airborne particulates are a major contributor to mortality and disability globally. However, work-related asthma remains under-recognised, poorly managed and inadequately compensated.
Background: Adherence to controller therapy in asthma is a major concern during the management of the disease. ... The adherence to asthma treatment was rated using Morisky Medication Adherence Scale. A ..... in an outpatient setting.
This self-instructional unit for supervisors and managers in the British hotel and catering industry is designed to prepare them for the more detailed units in this series, including those on food and beverage control, production, and provision. The document begins with advice on how to use the unit. Three sections cover the following topics: (1)…
Arakawa, Hirokazu; Hamasaki, Yuhei; Kohno, Yoichi; Ebisawa, Motohiro; Kondo, Naomi; Nishima, Sankei; Nishimuta, Toshiyuki; Morikawa, Akihiro
The Japanese Guideline for the Diagnosis and Treatment of Allergic Diseases 2017 (JAGL 2017) includes a minor revision of the Japanese Pediatric Guideline for the Treatment and Management of Asthma 2012 (JPGL 2012) by the Japanese Society of Pediatric Allergy and Clinical Immunology. The section on child asthma in JAGL 2017 provides information on how to diagnose asthma between infancy and adolescence (0-15 years of age). It makes recommendations for best practices in the management of childhood asthma, including management of acute exacerbations and non-pharmacological and pharmacological management. This guideline will be of interest to non-specialist physicians involved in the care of children with asthma. JAGL differs from the Global Initiative for Asthma Guideline in that JAGL emphasizes diagnosis and early intervention of children with asthma at asthma control levels, is easy to understand; thus, this guideline is suitable for the routine medical care of children with asthma. JAGL also recommends using a control test in children, so that the physician aims for complete control by avoiding exacerbating factors and appropriately using anti-inflammatory drugs (for example, inhaled corticosteroids and leukotriene receptor antagonists). Copyright © 2016 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.
Full Text Available Three factors in recent medical research and treatment (advances in the field of psychoneuroimmunology, epidemiological evidence regarding important interaction between psychosocial factors and development of disease, and the recognition of the importance of patient education for self-management of asthma have led clinicians and researchers to reconsider the role of psychosocial stress in asthma. There are many reports suggesting that stressful life events, family problems and a behavior pattern that increases psychological conflict may influence the development or relapse of asthma and influence its clinical course. Depression is known as one of the risk factors of fatal asthmatic attack. In laboratory studies, about 20% of asthmatics were considered reactors who showed an airway change after exposure to emotional stress. Studies regarding the pathway of stress effect on allergy and asthma are reviewed and discussed from the standpoint of psychoneuroimmunology; for example, the enhancement of IgE production and increased susceptibility to respiratory infection by stress, conditioned anaphylaxis and nerve/mast cell interaction, the effect of stress on various bronchial responses and the inhibition of the immediate and late asthmatic response by anterior hypothalamic lesioning.
Yu, Chwo-Ming Joseph; Guan, Jyh-Liang; Yang, Kuo-Pin; Chiao, Yu-Ching
This exploratory study addresses two issues: (1) how firms select applicants for positions in international management and, subsequently, evaluate the performance of international business education in Taiwan; and (2) what the important skills for international management professionals are, and how well university graduates are equipped with these…
Ortiz-Rivera, María Calixta
Objectives: This study evaluates social, behavioral, and environmental determinants to differentiate between active and inactive asthma and how predisposing, enabling, and need factors elucidate asthma-related health services and asthma control among women in Puerto Rico. Methods: This study analyzed secondary cross-sectional data from a subsample of 625 adult females who participated in the Asthma Call Back Survey in Puerto Rico. Logistic and multinomial regression analyses were conducted to examine associations between explanatory variables and asthma outcomes. Results: In total, 63% of women reported active asthma, from which 37.9% have not well controlled or very poorly controlled asthma. Women with active asthma were significantly more likely to be out of work, have middle income (US$25,000–
Liccardi, Gennaro; Salzillo, Antonello; Sofia, Matteo; D'Amato, Maria; D'Amato, Gennaro
The aim of this review is to underline the need for an adequate clinical and functional evaluation of respiratory function and asthma control in patients undergoing surgical procedures requiring general anesthesia to obtain useful information for an adequate preoperative pharmacological approach. It has been shown that baseline uncontrolled clinical/functional conditions of airways represent the most important risk factors for perioperative bronchospasm. In nonemergency conditions, asthma patients should undergo clinical/functional assessment at least 1 week before the surgery intervention to obtain, the better feasible control of asthma symptoms in the single patient. Some simple preoperative information given by the patient in preoperative consultation may be sufficient to identify individuals with uncontrolled or poor controlled asthmatic conditions. Spirometric evaluation is essential in individuals with poor control of symptoms, as well as in those patients with uncertain anamnestic data or limited perception of respiratory symptoms, and in those requiring lung resection. A better control of asthma must be considered the 'gold standard' for a patient at 'a reasonable low risk' to develop perioperative/postoperative bronchospasm. International consensus promoted by pulmonologists, anesthesiologists, and allergists might be useful to define a better diagnostic and therapeutic approach.
Garcia, Raul; Borrelli, Belinda; Dhar, Vineet
The 2014 Early Childhood Caries Conference encompassed evidence-based reviews on the state of the science regarding early childhood carries (ECC) epidemiology, etiology, prevention, and disease management. The purpose of this paper was to discuss the work presented at the conference and identify...... means to prevent and manage ECC. Analyses of studies indicate that some approaches, such as chlorhexidine, iodine, and remineralizing agents, have not shown consistent findings in preventing ECC. However, evidence exists to yield recommendations in some areas. There are useful risk assessment indicators...... opportunities in research, policy, and clinical management that may improve early childhood caries outcomes and lower costs of care. While great progress has been made since the 1997 ECC Conference, there remains a paucity of high-quality evidence from randomized controlled trials on what are the most effective...
Samantha E. Cruz-Sotelo
Full Text Available Electronic waste is a widespread environmental problem. From all waste streams, e-waste is registering one of the largest growing rates (between 3% and 5%. In Mexico, the e-waste recovery system comprises a mix of formal and informal sectors not well known to date. The goal of this article was to analyze electronic waste in Mexico through the active actors in the recovery chain. This article presents the evolution of studies on electronic waste in Mexico. The legal regulations and public policies were analyzed, as were the existing practices of electronic waste handling, and some challenges facing this country for waste flow management. A management model is proposed which highlights components that must be considered in the model and the opportunities and challenges to transition from an unbundled handling, which still has practices that lack environmental and technical support, to sustainable management.
Kelso, T M; Abou-Shala, N; Heilker, G M; Arheart, K L; Portner, T S; Self, T H
To determine if a comprehensive long-term management program, emphasizing inhaled corticosteroids and patient education, would improve outcomes in adult African-American asthmatics a nonrandomized control trial with a 2-year intervention was performed in a university-based clinic. Inclusion criteria consisted of (> or = 5) emergency department (ED) visits or hospitalizations (> or = 2) during the previous 2 years. Intervention patients were volunteers; a comparable control group was identified via chart review at hospitals within the same area and time period as the intervention patients. Individualized doses of beclomethasone with a spacer, inhaled albuterol "as needed," and crisis prednisone were the primary therapies. Environmental control, peak flow monitoring, and a partnership with the patient were emphasized. Detailed patient education was an integral part of management. Control patients received usual care from local physicians. ED visits and hospitalizations for 2 years before and 2 years during the intervention period were compared. Quality of life (QOL) measurements were made at baseline and every 6 months in the intervention group. Study group (n = 21) had a significant reduction in ED visits (2.3 +/- 0.2 pre-intervention versus 0.6 +/- 0.2 post-intervention; P = 0.0001). Control group (n = 18) did not have a significant change in ED visits during the 2-year post-intervention period (2.6 +/- 0.2 pre-intervention versus 2.0 +/- 0.2 post-intervention; P = 0.11). Both groups had significant reductions in hospitalizations, but the study group had a greater reduction. Sixty-two percent of study patients had complete elimination of ED visits and hospitalizations, whereas no control patients had total elimination of the need for institutional acute care. QOL in the study patients revealed significant improvements for most parameters. A comprehensive long-term management program emphasizing inhaled corticosteroids combined with other state-of-the-art management
Mashru, Mayur; Galib, R; Shukla, Vinay J; Ravishankar, B; Prajapati, Pradeep Kumar
Asthma represents a profound world-wide public health problem. The most effective anti-asthmatic drugs currently available include β2-agonists and glucocorticoids which can controls asthma in about 90-95% of patients. In Ayurveda, this miserable condition is comparable with Tamaka Shwasa type of Shwasa Roga. In the present study, 52 patients were treated with Sameera Pannaga Rasa at a dose of 30 mg twice a day for 4 weeks along with Nagavallidala (leaf of Piper betel Linn.) The results were assessed in terms of clinical recovery, symptomatic relief, pulmonary function improvement and on subjective and objective parameters. A significant improvement in subjective parameters, control on asthma, recurrence of asthma, increase in peak expiratory flow rate, considerable decrease in total and absolute, acute eosinophil count and erythrocyte sedimentation rate were observed. Overall marked improvement was found in 33.33%, moderate improvement in 44.44% and mild improvement in 20.00% was observed. The study reveals that Sameera Pannaga Rasa can be used as an effective drug in bronchial asthma.
Full Text Available Abstract Background Guidelines for the diagnosis and management of asthma have been published over the last 15 years; however, there has been little focus on issues relating to asthma in childhood. Since the last revision of the 1999 Canadian Asthma Consensus Report, important new studies, particularly in children, have highlighted the need to incorporate new information into the asthma guidelines. The objectives of this article are to review the literature on asthma published between January 2000 and June 2003 and to evaluate the influence of new evidence on the recommendations made in the 1999 Canadian Asthma Consensus Report and its 2001 update, with a major focus on pediatric issues. Methods The diagnosis of asthma in young children and prevention strategies, pharmacotherapy, inhalation devices, immunotherapy, and asthma education were selected for review by small expert resource groups. The reviews were discussed in June 2003 at a meeting under the auspices of the Canadian Network For Asthma Care and the Canadian Thoracic Society. Data published through December 2004 were subsequently reviewed by the individual expert resource groups. Results This report evaluates early-life prevention strategies and focuses on treatment of asthma in children, emphasizing the importance of early diagnosis and preventive therapy, the benefits of additional therapy, and the essential role of asthma education. Conclusion We generally support previous recommendations and focus on new issues, particularly those relevant to children and their families. This document is a guide for asthma management based on the best available published data and the opinion of health care professionals, including asthma experts and educators.
Dilling, Lisa; Kelsey, Katharine C.; Fernandez, Daniel P.; Huang, Yin D.; Milford, Jana B.; Neff, Jason C.
Federal lands in the United States have been identified as important areas where forests could be managed to enhance carbon storage and help mitigate climate change. However, there has been little work examining the context for decision making for carbon in a multiple-use public land environment, and how science can support decision making. This case study of the San Juan National Forest and the Bureau of Land Management Tres Rios Field Office in southwestern Colorado examines whether land managers in these offices have adequate tools, information, and management flexibility to practice effective carbon stewardship. To understand how carbon was distributed on the management landscape we added a newly developed carbon map for the SJNF-TRFO area based on Landsat TM texture information (Kelsey and Neff in Remote Sens 6:6407-6422. doi: 10.3390/rs6076407, 2014). We estimate that only about 22 % of the aboveground carbon in the SJNF-TRFO is in areas designated for active management, whereas about 38 % is in areas with limited management opportunities, and 29 % is in areas where natural processes should dominate. To project the effects of forest management actions on carbon storage, staff of the SJNF are expected to use the Forest Vegetation Simulator (FVS) and extensions. While identifying FVS as the best tool generally available for this purpose, the users and developers we interviewed highlighted the limitations of applying an empirically based model over long time horizons. Future research to improve information on carbon storage should focus on locations and types of vegetation where carbon management is feasible and aligns with other management priorities.
Epanchin-Niell, Rebecca S.; Boyd, James W.; Macauley, Molly K.; Scarlett, Lynn; Shapiro, Carl D.; Williams, Byron K.
Executive Summary—OverviewNatural resource managers must make decisions that affect broad-scale ecosystem processes involving large spatial areas, complex biophysical interactions, numerous competing stakeholder interests, and highly uncertain outcomes. Natural and social science information and analyses are widely recognized as important for informing effective management. Chief among the systematic approaches for improving the integration of science into natural resource management are two emergent science concepts, adaptive management and ecosystem services. Adaptive management (also referred to as “adaptive decision making”) is a deliberate process of learning by doing that focuses on reducing uncertainties about management outcomes and system responses to improve management over time. Ecosystem services is a conceptual framework that refers to the attributes and outputs of ecosystems (and their components and functions) that have value for humans.This report explores how ecosystem services can be moved from concept into practice through connection to a decision framework—adaptive management—that accounts for inherent uncertainties. Simultaneously, the report examines the value of incorporating ecosystem services framing and concepts into adaptive management efforts.Adaptive management and ecosystem services analyses have not typically been used jointly in decision making. However, as frameworks, they have a natural—but to date underexplored—affinity. Both are policy and decision oriented in that they attempt to represent the consequences of resource management choices on outcomes of interest to stakeholders. Both adaptive management and ecosystem services analysis take an empirical approach to the analysis of ecological systems. This systems orientation is a byproduct of the fact that natural resource actions affect ecosystems—and corresponding societal outcomes—often across large geographic scales. Moreover, because both frameworks focus on
... Videos for Educators Search English Español Exercise-Induced Asthma KidsHealth / For Parents / Exercise-Induced Asthma What's in ... Exercise-Induced Asthma Print What Is Exercise-Induced Asthma? Most kids and teens with asthma have symptoms ...
Fort, Meredith P; Castro, Maricruz; Peña, Liz; López Hernández, Sergio Hernán; Arreola Camacho, Gabriel; Ramírez-Zea, Manuel; Martínez, Homero
A healthy lifestyle intervention was implemented in primary care health centers in urban parts of Tuxtla Gutiérrez, Chiapas, Mexico with an aim of reducing cardiovascular disease risk for patients with type 2 diabetes and/or hypertension. During implementation, research questions emerged. Considerably fewer men participated in the intervention than women, and an opportunity was identified to increase the reach of activities aimed at improving disease self-management through strategies involving family members. A qualitative study was conducted to identify strategies to involve men and engage family members in disease management and risk reduction. Nine men with hypertension and/or type 2 diabetes with limited to no participation in disease self-management and health promotion activities, six families in which at least one family member had a diagnosis of one or both conditions, and nine health care providers from four different government health centers were recruited for the study. Participants took part in semi-structured interviews. During interviews with families, genograms and eco-maps were used to diagram family composition and structure, and capture the nature of patients' relationships to the extended family and community resources. Transcripts were coded and a general inductive analytic approach was used to identify themes related to men's limited participation in health promotion activities, family support and barriers to disease management, and health care providers' recommendations. Participants reported barriers to men's participation in chronic disease management and healthy lifestyle education activities that can be grouped into two categories: internal and external factors. Internal factors are those for which they are able to make the decision on their own and external factors are those that are not related solely to their decision to take part or not. Four primary aspects were identified related to families' relationships with disease: different
Castiglia, Daniela; Battaglia, Salvatore; Benfante, Alida; Sorino, Claudio; Scichilone, Nicola
Asthma and chronic obstructive pulmonary disease (COPD) are two distinct diseases that share a condition of chronic inflammation of the airways and bronchial obstruction. In clinical settings, it is not rare to come across patients who present with clinical and functional features of both diseases, posing a diagnostic dilemma. The overlap condition has been termed asthma-COPD overlap syndrome (ACOS), and mainly occurs in individuals with long-standing asthma, especially if they are also current or former smokers. Patients with ACOS have poorer health-related quality of life and a higher exacerbation rate than subjects with asthma or COPD alone. Whether ACOS is a distinct nosological entity with genetic variants or rather a condition of concomitant diseases that overlap is still a matter of debate. However, there is no doubt that extended life expectancy has increased the prevalence of asthma and COPD in older ages, and thus the probability that overlap conditions occur in clinical settings. In addition, age-associated changes of the lung create the basis for the two entities to converge on the same subject. ACOS patients may benefit from a stepwise treatment similar to that of asthma and COPD; however, the proposed therapeutic algorithms are only speculative and extrapolated from studies that are not representative of the ACOS population. Inhaled corticosteroids are the mainstay of therapy, and always in conjunction with long-acting bronchodilators. The potential heterogeneity of the overlap syndrome in terms of inflammatory features (T helper-1 vs. T helper-2 pathways) may be responsible for the different responses to treatments. The interaction between respiratory drugs and concomitant diseases should be carefully evaluated. Similarly, the effect of non-respiratory drugs, such as aspirin, statins, and β-blockers, on lung function needs to be properly assessed.
Red brome is a Mediterranean winter annual grass that has invaded south-western USA deserts. Unlike native annuals, it does not maintain a soil seed bank, but exhibits early and uniform germination. Above-average winter precipitation in these regions allows red brome to reach high density and biomass. These are time for concern, as large numbers of easily dispersed seeds increase the likelihood that it may spread into new areas. However, early and uniform germination can also lead to population crashes when drought precludes seed production. Winter droughts dramatically reduce densities of red brome, but provide opportunities for management of this exotic grass.
Bousquet, Jean; Bousquet, Philippe J; Godard, Philippe; Daures, Jean-Pierre
Asthma is a very common chronic disease that occurs in all age groups and is the focus of various clinical and public health interventions. Both morbidity and mortality from asthma are significant. The number of disability-adjusted life years (DALYs) lost due to asthma worldwide is similar to that for diabetes, liver cirrhosis and schizophrenia. Asthma management plans have, however, reduced mortality and severity in countries where they have been applied. Several barriers reduce the availability, affordability, dissemination and efficacy of optimal asthma management plans in both developed and developing countries. The workplace environment contributes significantly to the general burden of asthma. Patients with occupational asthma have higher rates of hospitalization and mortality than healthy workers. The surveillance of asthma as part of a global WHO programme is essential. The economic cost of asthma is considerable both in terms of direct medical costs (such as hospital admissions and the cost of pharmaceuticals) and indirect medical costs (such as time lost from work and premature death). Direct costs are significant in most countries. In order to reduce costs and improve quality of care, employers and health plans are exploring more precisely targeted ways of controlling rapidly rising health costs. Poor control of asthma symptoms is a major issue that can result in adverse clinical and economic outcomes. A model of asthma costs is needed to aid attempts to reduce them while permitting optimal management of the disease. This paper presents a discussion of the burden of asthma and its socioeconomic implications and proposes a model to predict the costs incurred by the disease.
Dürr, Selina; Hersberger, Kurt E; Zeller, Andreas; Scheuzger, Jonas; Miedinger, David; Gregoriano, Claudia; Leuppi, Jörg D; Steurer-Stey, Claudia
For successful long-term asthma care, self-management education is a cornerstone. Little is known about associations between patients' interest in education, asthma control and care delivery. We compared patients' characteristics, asthma control and patients' perspective about asthma care in subjects with and without interest in asthma education. Moreover, we assessed reasons, why patients denied participating in asthma education. Baseline data of 223 patients with asthma (age 43 ± 12 years, 38% male, 58% non-smokers, 13% current smokers), who participated in a multicentre longitudinal controlled study, are reported. At baseline, patients completed the Asthma Control Test (ACT), the Patient Assessment Chronic Illness Care questionnaire (PACIC 5A) and stated their interest in an asthma education programme. Overall, 34% of all participants showed uncontrolled asthma. One hundred and twenty-five (56%) patients were interested in education. Compared to patients without interest, they were characterised by male gender (p = 0.013), worse asthma control (p < 0.001), and perception of lower quality of chronic asthma care delivery, in particular lower self-management support (p < 0.001). Main reasons for rejecting asthma education were having sufficient asthma knowledge, having only mild asthma, receiving adequate medical support and lack of time. More than half of the patients were interested in asthma education. Interest was associated with worse asthma control and lower receipt of care according to the Chronic Care Model. Considering these aspects, this approach may help to improve care quality and allow targeting interventions to those patients who are interested in becoming active participants in their care and who might benefit most.
... Guidelines Asthma & Community Health Learn How to Control Asthma Language: English (US) Español (Spanish) Arabic Chinese Français ... Is Asthma Treated? Select a Language What Is Asthma? Asthma is a disease that affects your lungs. ...
... Español Text Size Email Print Share Asthma and Food Allergies Page Content Article Body A family history of ... child may develop asthma . Children with asthma and food allergies are at increased risk for anaphylaxis, a severe ...
Reactive airway disease - dust; Bronchial asthma - dust; Triggers - dust ... Things that make allergies or asthma worse are called triggers. Dust is a common trigger. When your asthma or allergies become worse due to dust, you are ...
Reactive airway - mold; Bronchial asthma - mold; Triggers - mold; Allergic rhinitis - pollen ... Things that make allergies or asthma worse are called triggers. Mold is a common trigger. When your asthma or allergies become worse due to mold, you are ...
... Videos for Educators Search English Español Traveling and Asthma KidsHealth / For Kids / Traveling and Asthma Print en ... pack it, too. How Can I Avoid My Asthma Triggers? Staying at a hotel Ask for a ...
This self-instructional unit for supervisors and managers in the British hotel and catering industry is designed to consolidate the work covered in a 1-day course. The document begins with an introduction and advice on how to use the unit. The following topics are covered: (1) the law and personnel procedures; (2) consultation and negotiation; (3)…
In this paper we address a difficult problem: How can we create and maintain preparedness for nuclear accidents? Our research has shown that this can be broken down into two questions: (1) How can we maintain the resources and expertise necessary to manage an accident once it occurs? and (2) How can we develop plans that will help in actually managing an accident once it occurs? It is apparently beyond the means of ordinary human organizations to maintain the capability to respond to a rare event. (A rare event is defined as something like an accident that only happens once every five years or so, somewhere in the world.) Other more immediate pressures tend to capture the resources that should, in a cost/benefit sense, be devoted to maintaining the capability. This paper demonstrates that some of the important factors behind that phenomenon can be mitigated by an international body that promotes and enforces preparedness. Therefore this problem provides a unique opportunity for international cooperation: an international organization promoting and enforcing preparedness could help save us from our own organizational failings. Developing useful accident management plans can be viewed as a human performance problem. It can be restated: how can we support and off-load the accident managers so that their tasks are more feasible? This question reveals the decision analytic perspective of this paper. That is, we look at the problem managing a nuclear accident by focusing on the decision makers, the accident managers: how do we create a decision frame for the accident managers to best help them manage? The decision frame is outlined and discussed. 9 refs
Holland, S M; Thomson, K D
Asthma is the commonest pre-existing medical condition to complicate pregnancy. Acute severe asthma in pregnancy is rare, but poses difficult problems. In particular, the decision about when and where to deliver the fetus is complex, since maternal response to asthma treatment is unpredictable. We report the successful management of a parturient presenting with acute severe asthma at 37 weeks' gestation. The controversies involved and the importance of adopting a multi-disciplinary team approach to optimise maternal and neonatal outcomes are discussed.
Tirumalasetty, Jyothi; Grammer, Leslie C
Over 20 million Americans are affected with asthma. Many will require some type of surgical procedure during which their asthma management should be optimized. Preoperative assessment of asthma should include a specialized history and physical as well as pulmonary function testing. In many asthmatic patients, treatment with systemic corticosteroids and bronchodilators is indicated to prevent the inflammation and bronchoconstriction associated with endotracheal intubation. The use of corticosteroids has not been shown to adversely affect wound healing or increase the rate of infections postoperatively. Preoperative systemic corticosteroids may be used safely in the majority of patients to decrease asthma-related morbidity.
Prognostics and health management is not a new concept. It has been used in relatively mature industries, such as aviation and electronics, to help improve operation and maintenance (O&M) practices. In the wind industry, prognostics and health management is relatively new. The level for both wind industry applications and research and development (R&D) has increased in recent years because of its potential for reducing O&M cost of wind power, especially for turbines installed offshore. The majority of wind industry application efforts has been focused on diagnosis based on various sensing and feature extraction techniques. For R&D, activities are being conducted in almost all areas of a typical prognostics and health management framework (i.e., sensing, data collection, feature extraction, diagnosis, prognosis, and maintenance scheduling). This presentation provides an overview of the current status of wind turbine prognostics and health management that focuses on drivetrain condition monitoring through vibration, oil debris, and oil condition analysis techniques. It also discusses turbine component health diagnosis through data mining and modeling based on supervisory control and data acquisition system data. Finally, it provides a brief survey of R&D activities for wind turbine prognostics and health management, along with future opportunities.
Asaria, M; Dhami, S; van Ree, R; Gerth van Wijk, R; Muraro, A; Roberts, G; Sheikh, A
The European Academy of Allergy and Clinical Immunology (EAACI) is developing guidelines for allergen immunotherapy (AIT) for the management of allergic rhinitis, allergic asthma, IgE-mediated food allergy and venom allergy. To inform the development of clinical recommendations, we undertook systematic reviews to critically assess evidence on the effectiveness, safety and cost-effectiveness of AIT for these conditions. This study focusses on synthesizing data and gaps in the evidence on the cost-effectiveness of AIT for these conditions. We produced summaries of evidence in each domain, and then, synthesized findings on health economic data identified from four recent systematic reviews on allergic rhinitis, asthma, food allergy and venom allergy, respectively. The quality of these studies was independently assessed using the Critical Appraisal Skills Programme tool for health economic evaluations. Twenty-three studies satisfied our inclusion criteria. Of these, 19 studies investigated the cost-effectiveness of AIT in allergic rhinitis, of which seven were based on data from randomized controlled trials with economic evaluations conducted from a health system perspective. This body of evidence suggested that sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) would be considered cost-effective using the (English) National Institute for Health and Clinical Excellence (NICE) cost-effectiveness threshold of £20 000/quality-adjusted life year (QALY). However, the quality of the studies and the general lack of attention to characterizing uncertainty and handling missing data should be taken into account when interpreting these results. For asthma, there were three eligible studies, all of which had significant methodological limitations; these suggested that SLIT, when used in patients with both asthma and allergic rhinitis, may be cost-effective with an incremental cost-effectiveness ratio (ICER) of £10 726 per QALY. We found one economic modelling
Amani K. Abu-Shaheen
Full Text Available Introduction. Parental perceptions and practices are important for improving the asthma outcomes in children; indeed, evidence shows that parents of asthmatic children harbor considerable misperceptions of the disease. Objective. To investigate the perceptions and practices of parents toward asthma and its management in Saudi children. Methods. Using a self-administered questionnaire, a two-stage cross-sectional survey of parents of children aged between 3 and 15 years, was conducted from schools located in Riyadh province in central Saudi Arabia. Results. During the study interval, 2000 parents were asked to participate in the study; 1450 parents responded, of whom 600 (41.4% reported that their children had asthma, dyspnea, or chest allergy (recurrent wheezing or coughing, while 478 (32.9% of the parents reported that their children were diagnosed earlier with asthma by a physician. Therefore, the final statistical analyses were performed with 600 participants. Furthermore, 321 (53.5% respondents believed that asthma is solely a hereditary disease. Interestingly, 361 (60.3% were concerned about side effects of inhaled corticosteroids and 192 (32% about the development of dependency on asthma medications. Almost 76% of parents had previously visited a pediatric emergency department during an asthma attack. Conclusions. Parents had misperceptions regarding asthma and exhibited ineffective practices in its management. Therefore, improving asthma care and compliance requires added parental education.
Abu-Shaheen, Amani K; Nofal, Abdullah; Heena, Humariya
Introduction . Parental perceptions and practices are important for improving the asthma outcomes in children; indeed, evidence shows that parents of asthmatic children harbor considerable misperceptions of the disease. Objective. To investigate the perceptions and practices of parents toward asthma and its management in Saudi children. Methods . Using a self-administered questionnaire, a two-stage cross-sectional survey of parents of children aged between 3 and 15 years, was conducted from schools located in Riyadh province in central Saudi Arabia. Results . During the study interval, 2000 parents were asked to participate in the study; 1450 parents responded, of whom 600 (41.4%) reported that their children had asthma, dyspnea, or chest allergy (recurrent wheezing or coughing), while 478 (32.9%) of the parents reported that their children were diagnosed earlier with asthma by a physician. Therefore, the final statistical analyses were performed with 600 participants. Furthermore, 321 (53.5%) respondents believed that asthma is solely a hereditary disease. Interestingly, 361 (60.3%) were concerned about side effects of inhaled corticosteroids and 192 (32%) about the development of dependency on asthma medications. Almost 76% of parents had previously visited a pediatric emergency department during an asthma attack. Conclusions . Parents had misperceptions regarding asthma and exhibited ineffective practices in its management. Therefore, improving asthma care and compliance requires added parental education.
Heffner, Kathi L; Ginsburg, G P; Hartley, Terry R
This study examined how threat and coping appraisals and impression management opportunities influenced cardiovascular reactivity within a self-presentation context. Participants were videotaped performing a speech that they believed might be evaluated. Participants' physiological responses were recorded 1 week later while: (a) watching their speech, indicating which portions they wished to re-shoot before it was evaluated,;(b) simply watching their speech; or (c) watching an architectural videotape and indicating which portions should be reshot, and also watching their own speech, but without evaluation concerns. Cardiovascular reactivity was influenced by the presence or absence of the impression management opportunity, but more variance in reactivity was explained when participants' threat and coping appraisals were also taken into account. The specific cardiovascular responses pertinent to goal-relevant action within each condition were the only responses related to appraisals. These findings emphasize the importance of considering both the situation and the state of the individual in that situation when attempting to understand social psychological influences on physiological reactivity.
Objective: To investigate the knowledge and use of asthma control measurement (ACM) tools in the management of asthma among doctors working in family and internal medicine practice in Nigeria. Method: A questionnaire based on the global initiative on asthma (GINA) guideline was self-administered by 194 doctors.
Bremerich, D H
Asthma is defined as a chronic inflammatory airway disease in response to a wide variety of provoking stimuli. Characteristic clinical symptoms of asthma are bronchial hyperreactivity, reversible airway obstruction, wheezing and dyspnea. Asthma presents a major public health problem with increasing prevalence rates and severity worldwide. Despite major advances in our understanding of the clinical management of asthmatic patients, it remains a challenging population for anesthesiologists in clinical practice. The anesthesiologist's responsibility starts with the preoperative assessment and evaluation of the pulmonary function. For patients with asthma who currently have no symptoms, the risk of perioperative respiratory complications is extremely low. Therefore, pulmonary function should be optimized preoperatively and airway obstruction should be controlled by using steroids and bronchodilators. Preoperative spirometry is a simple means of assessing presence and severity of airway obstruction as well as the degree of reversibility in response to bronchodilator therapy. An increase of 15% in FEV1 is considered clinically significant. Most asymptomatic persons with asthma can safely undergo general anesthesia with and without endotracheal intubation. Volatile anesthetics are still recommended for general anesthetic techniques. As compared to barbiturates and even ketamine, propofol is considered to be the agent of choice for induction of anesthesia in asthmatics. The use of regional anesthesia does not reduce perioperative respiratory complications in asymptomatic asthmatics, whereas it is advantageous in symptomatic patients. Pregnant asthmatic and parturients undergoing anesthesia are at increased risk, especially if regional anesthetic techniques are not suitable and prostaglandin and its derivates are administered for abortion or operative delivery. Bronchial hyperreactivity associated with asthma is an important risk factor of perioperative bronchospasm. The
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-line anti-inflammatory therapy for asthma management. However, in some patients, especially children, the high doses of corticosteroids that may be required to control features of hyperresponsiveness, including exercise-induced asthma, raise safety concerns. Thus, there is a need for complementary anti...
... they want — even endurance or cold-weather sports . Sports can boost your mood, and that's a great help for those times when you may feel frustrated about having asthma. Using a management plan to deal with asthma is good for ...
Brewer, Michael J; Hoard, Robert J; Landis, Joy N; Elworth, Lawrence E
Food, water, and worker protection regulations have driven availability, and loss, of pesticides for use in pest management programs. In response, public-supported research and extension projects have targeted investigation and demonstration of reduced-risk integrated pest management (IPM) techniques. But these new techniques often result in higher financial burden to the grower, which is counter to the IPM principle that economic competitiveness is critical to have IPM adopted. As authorized by the 2002 Farm Bill and administered by the U.S. Department of Agriculture (USDA) Natural Resources Conservation Service (NRCS), conservation programs exist for delivering public-supported financial incentives to growers to increase environmental stewardship on lands in production. NRCS conservation programs are described, and the case for providing financial incentives to growers for implementing IPM is presented. We also explored the opportunity and challenge to use one key program, the Environmental Quality Incentives Program (EQIP), to aid grower adoption of IPM. The EQIP fund distribution to growers from 1997 to 2002 during the last Farm Bill cycle totaled approximately 1.05 billion dollars with a portion of funds supporting an NRCS-designed pest management practice. The average percentage of allocation of EQIP funds to this pest management practice among states was 0.77 +/- 0.009% (mean +/- SD). Using Michigan as an example, vegetable and fruit grower recognition of the program's use to implement IPM was modest (25% of growers surveyed), and their recognition of its use in aiding implementation of IPM was improved after educational efforts (74%). Proposals designed to enhance program usefulness in implementing IPM were delivered through the NRCS advisory process in Michigan. Modifications for using the NRCS pest management practice to address resource concerns were adopted, incentive rates for pest management were adjusted, and an expanded incentive structure for IPM
Butz, Arlene M.; Walker, Jennifer; Land, Cassia Lewis; Vibbert, Carrie; Winkelstein, Marilyn
Few child asthma studies address the specific content and techniques needed to enhance child communication during asthma preventive care visits. This study examined the content of child and parent communications regarding their asthma management during a medical encounter with their primary care provider (PCP). The majority of parents and children required prompting to communicate symptom information to the PCP during the clinic visit. Some high-risk families may require an asthma advocate to...
Full Text Available Background: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation. Methods: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version. Results: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included. After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication. Conclusion: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico.
Harden, Jennifer W.; Hugelius, Gustaf; Ahlström, Anders; Blankinship, Joseph C.; Bond-Lamberty, Ben; Lawrence, Corey; Loisel, Julie; Malhotra, Avni; Jackson, Robert B.; Ogle, Stephen M.; Phillips, Claire; Ryals, Rebecca; Todd-Brown, Katherine; Vargas, Rodrigo; Vergara, Sintana E.; Cotrufo, M. Francesca; Keiluweit, Marco; Heckman, Katherine; Crow, Susan E.; Silver, Whendee L.; DeLonge, Marcia; Nave, Lucas E.
Soil organic matter (SOM) supports the Earth's ability to sustain terrestrial ecosystems, provide food and fiber, and retains the largest pool of actively cycling carbon. Over 75% of the soil organic carbon (SOC) in the top meter of soil is directly affected by human land use. Large land areas have lost SOC as a result of land use practices, yet there are compensatory opportunities to enhance productivity and SOC storage in degraded lands through improved management practices. Large areas with and without intentional management are also being subjected to rapid changes in climate, making many SOC stocks vulnerable to losses by decomposition or disturbance. In order to quantify potential SOC losses or sequestration at field, regional, and global scales, measurements for detecting changes in SOC are needed. Such measurements and soil-management best practices should be based on well established and emerging scientific understanding of processes of C stabilization and destabilization over various timescales, soil types, and spatial scales. As newly engaged members of the International Soil Carbon Network, we have identified gaps in data, modeling, and communication that underscore the need for an open, shared network to frame and guide the study of SOM and SOC and their management for sustained production and climate regulation.
Harden, Jennifer W. [Stanford Univ., Stanford, CA (United States); U.S. Geological Survey, Menlo Park, CA (United States); Hugelius, Gustaf [Stanford Univ., Stanford, CA (United States); Stockholm Univ., Stockholm (Sweden); Ahlstrom, Anders [Stanford Univ., Stanford, CA (United States); Department of Physical Geography and Ecosystem Science, Lund (Sweden); Blankinship, Joseph C. [Univ. of Arizona, Tucson, AZ (United States); Bond-Lamberty, Ben [Univ. of Maryland, College Park, MD (United States); Lawrence, Corey R. [U.S. Geological Survey, Denver, CO (United States); Loisel, Julie [Texas A & M Univ., College Station, TX (United States); Malhotra, Avni [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Jackson, Robert B. [Stanford Univ., Stanford, CA (United States); Ogle, Stephen [Colorado State Univ., Fort Collins, CO (United States); Phillips, Claire [USDA-ARS Forage Seed and Cereal Research Unit, Corvallis, OR (United States); Ryals, Rebecca [Univ. of Hawai' i at Manoa, Honolulu, HI (United States); Todd-Brown, Katherine [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Vargas, Rodrigo [Univ. of Delaware, Newark, DE (United States); Vergara, Sintana E. [Univ. of California, Berkeley, CA (United States); Cotrufo, M. Francesca [Colorado State Univ., Fort Collins, CO (United States); Keiluweit, Marco [Univ. of Massachusetts, Amherst, MA (United States); Heckman, Katherine A. [USDA Forest Service, Houghton, MI (United States); Crow, Susan E. [Univ. of Hawai' i at Manoa, Honolulu, HI (United States); Silver, Whendee L. [Univ. of California, Berkeley, CA (United States); DeLonge, Marcia [Union of Concerned Scientists, Washington, D.C. (United States); Nave, Lucas E. [Univ. of Michigan, Pellston, MI (United States)
Here, soil organic matter supports the Earth’s ability to sustain terrestrial ecosystems, provide food and fiber, and retain the largest pool of actively cycling carbon (C). Over 75% of the soil organic carbon (SOC) in the top meter of soil is directly affected by human land use. Large land areas have lost SOC as a result of land use practices, yet there are compensatory opportunities to enhance land productivity and SOC storage in degraded lands through improved management practices. Large areas with and without intentional management are also being subjected to rapid changes in climate, making many SOC stocks vulnerable to losses by decomposition or disturbance. In order to quantify potential SOC losses or sequestration at field, regional, and global scales, measurements for detecting changes in SOC are needed. Such measurements and soil-management best practices should be based on well-established and emerging scientific understanding of processes of C stabilization and destabilization over various timescales, soil types, and spatial scales. As newly engaged members of the International Soil Carbon Network, we have identified gaps in data, modeling, and communication that underscore the need for an open, shared network to frame and guide the study of soil organic matter and C and their management for sustained production and climate regulation.